Provider Demographics
NPI:1942238639
Name:MARCHERT-EATON, JENNIFER (OT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARCHERT-EATON
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:W239N1812 ROCKWOOD DR STE 100
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1113
Mailing Address - Country:US
Mailing Address - Phone:262-523-0310
Mailing Address - Fax:262-532-9587
Practice Address - Street 1:W239N1812 ROCKWOOD DR STE 100
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1113
Practice Address - Country:US
Practice Address - Phone:262-523-0310
Practice Address - Fax:262-532-9587
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2643225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40814400Medicaid
68375Medicare PIN
WI40814400Medicaid