Healthcare Provider Details

I. General information

NPI: 1285823161
Provider Name (Legal Business Name): ANN V. JOHN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4922 COLUMBIA RD
CEDARBURG WI
53012-9188
US

IV. Provider business mailing address

4922 COLUMBIA RD
CEDARBURG WI
53012-9188
US

V. Phone/Fax

Practice location:
  • Phone: 262-377-4077
  • Fax: 262-377-7358
Mailing address:
  • Phone: 262-377-4077
  • Fax: 262-377-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1166
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number1166
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number1166
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: