Healthcare Provider Details

I. General information

NPI: 1700979309
Provider Name (Legal Business Name): NANCY ANN BELLENDORF OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY ANN HAAS OTR

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S GIBSON ST
MEDFORD WI
54451
US

IV. Provider business mailing address

135 S GIBSON ST
MEDFORD WI
54451-1622
US

V. Phone/Fax

Practice location:
  • Phone: 715-748-8112
  • Fax: 715-748-8792
Mailing address:
  • Phone: 715-748-8100
  • Fax: 715-748-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number592-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: