Healthcare Provider Details

I. General information

NPI: 1336785633
Provider Name (Legal Business Name): BETH A STRANGSTALIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S JEFFERSON ST FL 2
LANCASTER WI
53813-1672
US

IV. Provider business mailing address

845 S CHESTNUT ST APT 103E
PLATTEVILLE WI
53818-3700
US

V. Phone/Fax

Practice location:
  • Phone: 608-723-6416
  • Fax:
Mailing address:
  • Phone: 608-422-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number562827
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: