Healthcare Provider Details

I. General information

NPI: 1134328032
Provider Name (Legal Business Name): OCCUCARE SYSTEMS & SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 30TH AVE
KENOSHA WI
53144-1957
US

IV. Provider business mailing address

3915 30TH AVE
KENOSHA WI
53144-1957
US

V. Phone/Fax

Practice location:
  • Phone: 262-657-0222
  • Fax: 262-657-7190
Mailing address:
  • Phone: 262-657-0222
  • Fax: 262-657-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARMELO D. TENUTA
Title or Position: PRESIDENT/CEO
Credential: PT
Phone: 262-657-0222