Healthcare Provider Details

I. General information

NPI: 1881808848
Provider Name (Legal Business Name): ERIK DAVID RASMUSON OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 26TH AVE
MONROE WI
53566-1531
US

IV. Provider business mailing address

5617 POLWORTH ST
FITCHBURG WI
53711-5485
US

V. Phone/Fax

Practice location:
  • Phone: 608-329-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3906026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: