Healthcare Provider Details

I. General information

NPI: 1184671182
Provider Name (Legal Business Name): BETH A. CARIGNAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E NEWPORT AVE
MILWAUKEE WI
53211-2906
US

IV. Provider business mailing address

1607 E LAKE BLUFF BLVD
SHOREWOOD WI
53211-1516
US

V. Phone/Fax

Practice location:
  • Phone: 414-298-6884
  • Fax:
Mailing address:
  • Phone: 414-332-4108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3288-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: