Healthcare Provider Details

I. General information

NPI: 1285985150
Provider Name (Legal Business Name): JEAN MARIE DEPREY OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PATRICK BLVD STE 250
BROOKFIELD WI
53045-5883
US

IV. Provider business mailing address

200 N PATRICK BLVD STE 250
BROOKFIELD WI
53045-5883
US

V. Phone/Fax

Practice location:
  • Phone: 414-865-0398
  • Fax:
Mailing address:
  • Phone: 414-865-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7062-26
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: