Provider Demographics
NPI:1861672792
Name:OCCUPATIONAL THERAPY AND HAND CLINIC LLC
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY AND HAND CLINIC LLC
Other - Org Name:AKA OT AND HAND CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SINGLE MEMBER OWNER LLC
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUHL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:262-335-2094
Mailing Address - Street 1:279 S 17TH AVE
Mailing Address - Street 2:ST 10A
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-335-2094
Mailing Address - Fax:262-335-2105
Practice Address - Street 1:279 S 17TH AVE
Practice Address - Street 2:ST 10A
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095
Practice Address - Country:US
Practice Address - Phone:262-335-2094
Practice Address - Fax:262-335-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2453026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty