Provider Demographics
NPI:1952631582
Name:FRITSCH, ERICA MARIE (MOT/OTR)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:MARIE
Last Name:FRITSCH
Suffix:
Gender:F
Credentials:MOT/OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 BOWEN ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2356
Mailing Address - Country:US
Mailing Address - Phone:920-233-4011
Mailing Address - Fax:920-235-2135
Practice Address - Street 1:1850 BOWEN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2356
Practice Address - Country:US
Practice Address - Phone:920-233-4011
Practice Address - Fax:920-235-2135
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4569-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40826400Medicaid