Provider Demographics
NPI:1942420302
Name:MOHR, JEAN MARIE (CERTIFIED OCCUPATION)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:MOHR
Suffix:
Gender:F
Credentials:CERTIFIED OCCUPATION
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CERTIFIED OCCUPATION
Mailing Address - Street 1:2132 S 94TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1406
Mailing Address - Country:US
Mailing Address - Phone:414-541-4980
Mailing Address - Fax:414-760-1372
Practice Address - Street 1:6800 NO.76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-9539
Practice Address - Country:US
Practice Address - Phone:414-353-5000
Practice Address - Fax:414-760-1372
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI955-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant