Provider Demographics
NPI:1902196538
Name:ULRICH, CATHERINE ROSE (OT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ROSE
Last Name:ULRICH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 DOUGLAS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-2034
Mailing Address - Country:US
Mailing Address - Phone:262-939-4119
Mailing Address - Fax:262-681-8830
Practice Address - Street 1:5401 DOUGLAS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-2034
Practice Address - Country:US
Practice Address - Phone:262-939-4119
Practice Address - Fax:262-681-8830
Is Sole Proprietor?:No
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3359-26225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation