Provider Demographics
NPI:1205958253
Name:BLAHA, ROBERTA ANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:ANN
Last Name:BLAHA
Suffix:
Gender:
Credentials:OTR
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:ANN
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2700 W 9TH AVE STE 101A
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7201
Mailing Address - Country:US
Mailing Address - Phone:920-223-7250
Mailing Address - Fax:
Practice Address - Street 1:2700 W 9TH AVE STE 101A
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7201
Practice Address - Country:US
Practice Address - Phone:920-223-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4240026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist