Healthcare Provider Details

I. General information

NPI: 1134826084
Provider Name (Legal Business Name): SEE CHANGE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1478 KENWOOD DR STE 104
MENASHA WI
54952-1161
US

IV. Provider business mailing address

1477 KENWOOD DR STE 200
MENASHA WI
54952-1160
US

V. Phone/Fax

Practice location:
  • Phone: 920-538-6368
  • Fax:
Mailing address:
  • Phone: 920-538-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. SHILOH JORDAN BESAW
Title or Position: BOARD PRESIDENT
Credential: LMT
Phone: 920-538-6368