MEDICARE: DUSTIN DRATH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5454-26	WI

General Provider Information

NPI Number	:	1033511357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN DRATH

Provider Business Mailing Address
First Line	:	500 RUSSELL DR W
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-8845
Country	:	US
Telephone Number	:	920-538-2148
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 RUSSELL DR W
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-8845
Country	:	US
Telephone Number	:	920-538-2148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	09/17/2014

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Directions to “ DUSTIN DRATH ” Practice Location

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