Healthcare Provider Details

I. General information

NPI: 1902882566
Provider Name (Legal Business Name): MICHELLE M RENTMEESTER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N WEBSTER AVE
GREEN BAY WI
54301-4813
US

IV. Provider business mailing address

215 N WEBSTER AVE
GREEN BAY WI
54301-4813
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-3638
  • Fax:
Mailing address:
  • Phone: 920-433-3638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3093
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: