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NPI Code Detail

MEDICARE: JANICE DERHAAG OTR

MEDICARE:   JANICE  DERHAAG  OTR
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 Therapist4643-026WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538323415
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANICE DERHAAG OTR
Provider Business Mailing Address
First Line : 4868 183RD ST
Second Line :
City : CHIPPEWA FALLS
State : WI
Zip : 54729-4123
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2815 COUNTY HIGHWAY I
Second Line :
City : CHIPPEWA FALLS
State : WI
Zip : 54729-2656
Country : US
Telephone Number : 715-723-9348
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2008
Last Update Date : 03/31/2010

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Directions to “ JANICE DERHAAG OTR” Practice Location

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