Healthcare Provider Details

I. General information

NPI: 1407172695
Provider Name (Legal Business Name): KAREN SUE VESPERMAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN SUE O'LEARY OTR

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 TRUAX BLVD
EAU CLAIRE WI
54703-1474
US

IV. Provider business mailing address

1405 TRUAX BLVD
EAU CLAIRE WI
54703-1474
US

V. Phone/Fax

Practice location:
  • Phone: 715-552-1030
  • Fax:
Mailing address:
  • Phone: 715-833-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2363-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: