Provider Demographics
NPI:1881869949
Name:PFANKUCH, SHARI L (OTR)
Entity type:Individual
Prefix:MRS
First Name:SHARI
Middle Name:L
Last Name:PFANKUCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:L
Other - Last Name:BRUCKSCHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OCCUPATIONAL THER
Mailing Address - Street 1:W6116 PINE LANE
Mailing Address - Street 2:SHARI PFANKUCH
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114
Mailing Address - Country:US
Mailing Address - Phone:715-927-4010
Mailing Address - Fax:715-854-7501
Practice Address - Street 1:100 E HIGHLAND DRIVE
Practice Address - Street 2:SHARPE CARE
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154
Practice Address - Country:US
Practice Address - Phone:920-848-3272
Practice Address - Fax:920-848-7833
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI654026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40686900Medicaid