Provider Demographics
NPI:1922073238
Name:SPERBER, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SPERBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 PINE ST
Mailing Address - Street 2:PO BOX 220
Mailing Address - City:STANLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54768-0220
Mailing Address - Country:US
Mailing Address - Phone:715-644-6181
Mailing Address - Fax:715-644-6183
Practice Address - Street 1:1120 PINE ST
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:WI
Practice Address - Zip Code:54768-0220
Practice Address - Country:US
Practice Address - Phone:715-644-6181
Practice Address - Fax:715-644-6183
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI326-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant