Healthcare Provider Details

I. General information

NPI: 1326653700
Provider Name (Legal Business Name): ANIKA BLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 TRAVIS ST
LA CROSSE WI
54601-6835
US

IV. Provider business mailing address

2405 TRAVIS ST
LA CROSSE WI
54601-6835
US

V. Phone/Fax

Practice location:
  • Phone: 608-789-7600
  • Fax:
Mailing address:
  • Phone: 608-789-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number875926
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: