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NPI Code Detail

MEDICARE: MRS. CASSANDRA ANN WANEK OTR/L

MEDICARE: MRS. CASSANDRA ANN WANEK OTR/L
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
1225X00000XOccupational Therapist

General Provider Information

NPI Number : 1346592987
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CASSANDRA ANN WANEK OTR/L
Provider Business Mailing Address
First Line : 28518 GAWIN DR
Second Line :
City : WATERFORD
State : WI
Zip : 53185-3039
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2507 N RICHMOND RD
Second Line :
City : MCHENRY
State : IL
Zip : 60051-5407
Country : US
Telephone Number : 815-363-2350
Fax Number : 815-344-6473
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2012
Last Update Date : 10/05/2012

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