Healthcare Provider Details

I. General information

NPI: 1720901721
Provider Name (Legal Business Name): MICHAELA RAE VANHANDEL SIMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 E EVERGREEN DR
APPLETON WI
54913-8910
US

IV. Provider business mailing address

W5067 HARRISON RD
HILBERT WI
54129-9376
US

V. Phone/Fax

Practice location:
  • Phone: 920-969-5353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: