Provider Demographics
NPI:1336352715
Name:DARGA, CATHERINE AGNES (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:AGNES
Last Name:DARGA
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:N9186 LEGLER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:WI
Mailing Address - Zip Code:53521-9715
Mailing Address - Country:US
Mailing Address - Phone:608-455-1917
Mailing Address - Fax:
Practice Address - Street 1:516 26TH AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1531
Practice Address - Country:US
Practice Address - Phone:608-325-9141
Practice Address - Fax:608-329-6594
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI499-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40628200Medicaid