Healthcare Provider Details

I. General information

NPI: 1013833821
Provider Name (Legal Business Name): AVERI LEE BOHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 BLUESTEM BLVD STE E
ALTOONA WI
54720-2676
US

IV. Provider business mailing address

3427 MARKGRAFF RD
FALL CREEK WI
54742-6337
US

V. Phone/Fax

Practice location:
  • Phone: 715-727-5621
  • Fax: 608-716-5610
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: