Provider Demographics
NPI:1881897536
Name:REISSIG, DENISE (OT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:REISSIG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W. 14TH
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720
Mailing Address - Country:US
Mailing Address - Phone:618-398-4118
Mailing Address - Fax:847-881-9640
Practice Address - Street 1:141 MARKET PL
Practice Address - Street 2:SUITE 203
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2034
Practice Address - Country:US
Practice Address - Phone:618-398-4118
Practice Address - Fax:847-881-9640
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701624225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist