Healthcare Provider Details

I. General information

NPI: 1346912185
Provider Name (Legal Business Name): SEAN ANDREW CUDD OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 ENLOE ST
HUDSON WI
54016-8173
US

IV. Provider business mailing address

2705 ENLOE ST
HUDSON WI
54016-8173
US

V. Phone/Fax

Practice location:
  • Phone: 715-690-2600
  • Fax: 715-381-8131
Mailing address:
  • Phone: 715-690-2600
  • Fax: 715-381-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7115-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: