Provider Demographics
NPI:1215214192
Name:REED, SUE A (AT)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:REED
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 W LIEBAU RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3396
Mailing Address - Country:US
Mailing Address - Phone:262-243-4167
Mailing Address - Fax:262-243-4166
Practice Address - Street 1:1249 W LIEBAU RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3396
Practice Address - Country:US
Practice Address - Phone:262-243-4167
Practice Address - Fax:262-243-4166
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI339-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer