Healthcare Provider Details

I. General information

NPI: 1871922252
Provider Name (Legal Business Name): CATHERINE PAPENDORF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 26TH AVE
MONROE WI
53566-1531
US

IV. Provider business mailing address

N3596 AEBLY RD
MONROE WI
53566-9360
US

V. Phone/Fax

Practice location:
  • Phone: 608-325-9141
  • Fax:
Mailing address:
  • Phone: 608-558-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4383-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: