Healthcare Provider Details

I. General information

NPI: 1558344663
Provider Name (Legal Business Name): RHONDA CATHERINE MAYNE OPA-C, OTC, OT-SC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 S IOWA ST SUITE 104
DODGEVILLE WI
53533-1900
US

IV. Provider business mailing address

E4051 STEVEN WAY
SPRING GREEN WI
53588-9271
US

V. Phone/Fax

Practice location:
  • Phone: 608-935-3339
  • Fax:
Mailing address:
  • Phone: 608-588-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: