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NPI Code Detail

MEDICARE: LISA ANNE DORENBUSH OTR/L

MEDICARE:   LISA ANNE DORENBUSH  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 Therapist4503-026WI

General Provider Information

NPI Number : 1699949230
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ANNE DORENBUSH OTR/L
Provider Business Mailing Address
First Line : 1637 HALLEWOOD BLVD
Second Line :
City : NEW RICHMOND
State : WI
Zip : 54017-2400
Country : US
Telephone Number : 715-246-7647
Fax Number :
Provider Business Practice Location Address
First Line : 1637 HALLEWOOD BLVD
Second Line :
City : NEW RICHMOND
State : WI
Zip : 54017-2400
Country : US
Telephone Number : 715-246-7647
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2008
Last Update Date : 04/15/2008

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Directions to “ LISA ANNE DORENBUSH OTR/L” Practice Location

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