Healthcare Provider Details

I. General information

NPI: 1043501901
Provider Name (Legal Business Name): BRIDGET KARI GRACNER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1507
US

IV. Provider business mailing address

202 S PARK ST
MADISON WI
53715-1507
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6000
  • Fax: 608-417-5785
Mailing address:
  • Phone: 608-417-6000
  • Fax: 608-417-5785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number3146-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: