Healthcare Provider Details

I. General information

NPI: 1114078037
Provider Name (Legal Business Name): DANA LYNN ERICKSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANA LYNN GULKE OTR

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 MILL ST
HORICON WI
53032-1461
US

IV. Provider business mailing address

813 LYNN ST
HORICON WI
53032-1110
US

V. Phone/Fax

Practice location:
  • Phone: 920-485-4423
  • Fax: 920-485-4318
Mailing address:
  • Phone: 920-485-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number591-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: