Healthcare Provider Details

I. General information

NPI: 1619496296
Provider Name (Legal Business Name): EMILY BRUEGGEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date: 01/16/2022
Reactivation Date: 07/27/2026

III. Provider practice location address

304 KAPHAEM RD
TOMAHAWK WI
54487-7800
US

IV. Provider business mailing address

304 KAPHAEM RD
TOMAHAWK WI
54487-7800
US

V. Phone/Fax

Practice location:
  • Phone: 715-453-2141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6083-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: