Healthcare Provider Details

I. General information

NPI: 1528235082
Provider Name (Legal Business Name): KAREN BESIADA HANSEN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN BESIADA OTR

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 POTTS AVE
GREEN BAY WI
54304-4535
US

IV. Provider business mailing address

2900 CURRY LN
GREEN BAY WI
54311-5857
US

V. Phone/Fax

Practice location:
  • Phone: 920-491-9079
  • Fax: 920-491-9082
Mailing address:
  • Phone: 920-496-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number849-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: