Healthcare Provider Details

I. General information

NPI: 1083488159
Provider Name (Legal Business Name): TORY GABRIELLE HOUDEK OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13203 GLOBE DR STE 111
MOUNT PLEASANT WI
53177-1616
US

IV. Provider business mailing address

13203 GLOBE DR STE 111
MOUNT PLEASANT WI
53177-1616
US

V. Phone/Fax

Practice location:
  • Phone: 262-287-0090
  • Fax:
Mailing address:
  • Phone: 262-287-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8439-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: