Provider Demographics
NPI:1881806487
Name:ZEEVELD, MIRANDA
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:ZEEVELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 TRI PARK WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1601
Mailing Address - Country:US
Mailing Address - Phone:920-830-6697
Mailing Address - Fax:
Practice Address - Street 1:300 MILL ST
Practice Address - Street 2:EMPLOYEE HEALTH CENTER
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-1807
Practice Address - Country:US
Practice Address - Phone:920-467-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1954-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41038900Medicaid