Healthcare Provider Details

I. General information

NPI: 1235826843
Provider Name (Legal Business Name): GINA MARIA ZADER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 W DOYNE AVE
MILWAUKEE WI
53226-1222
US

IV. Provider business mailing address

N9587 HORSESHOE LN
MUKWONAGO WI
53149-1848
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-5879
  • Fax:
Mailing address:
  • Phone: 414-588-8174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number1566-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: