Provider Demographics
NPI:1336203736
Name:FIEGEL, CONNIE LYNN (OTR)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:LYNN
Last Name:FIEGEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2054
Mailing Address - Country:US
Mailing Address - Phone:920-885-6563
Mailing Address - Fax:
Practice Address - Street 1:950 WILCOX ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-2283
Practice Address - Country:US
Practice Address - Phone:920-324-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI586-026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist