Provider Demographics
NPI:1932293529
Name:VOLLMERS, DAVE (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:DAVE
Middle Name:
Last Name:VOLLMERS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 NORTH 92ND STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222
Mailing Address - Country:US
Mailing Address - Phone:414-778-1341
Mailing Address - Fax:414-778-1342
Practice Address - Street 1:2711 NORTH 92ND STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222
Practice Address - Country:US
Practice Address - Phone:414-778-1341
Practice Address - Fax:414-778-1342
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2921-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI752985739OtherTRICARE ID NUMBER
WI30-0807887OtherTAX ID NUMBER
WI30-0807887OtherTAX ID NUMBER
WI85048Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID