Healthcare Provider Details

I. General information

NPI: 1558278861
Provider Name (Legal Business Name): RYAN PING OTD, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 4TH ST
BELOIT WI
53511-4418
US

IV. Provider business mailing address

1500 4TH ST
BELOIT WI
53511-4418
US

V. Phone/Fax

Practice location:
  • Phone: 608-361-4000
  • Fax:
Mailing address:
  • Phone: 608-361-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8663-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: