Provider Demographics
NPI:1912043183
Name:PURDY, NANCY DAVIDSON (OTR, CLT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:DAVIDSON
Last Name:PURDY
Suffix:
Gender:F
Credentials:OTR, CLT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JEAN
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:412 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1112
Mailing Address - Country:US
Mailing Address - Phone:608-325-2591
Mailing Address - Fax:815-235-1854
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-1178
Practice Address - Fax:608-324-1214
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2610-026225X00000X
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist