Healthcare Provider Details

I. General information

NPI: 1972148211
Provider Name (Legal Business Name): ADAPTIVE TECHNOLOGY RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W175N11163 STONEWOOD DR STE 232
GERMANTOWN WI
53022-6503
US

IV. Provider business mailing address

W175N11163 STONEWOOD DR STE 232
GERMANTOWN WI
53022-6503
US

V. Phone/Fax

Practice location:
  • Phone: 262-375-2020
  • Fax: 262-375-6777
Mailing address:
  • Phone: 262-375-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD RAYMOND ZILLER
Title or Position: PRESIDENT
Credential: MOTR/L
Phone: 262-375-2020