Healthcare Provider Details

I. General information

NPI: 1568109007
Provider Name (Legal Business Name): JESSICA ANNE NEEVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 2ND ST
NEENAH WI
54956-2883
US

IV. Provider business mailing address

130 2ND ST
NEENAH WI
54956-2883
US

V. Phone/Fax

Practice location:
  • Phone: 920-729-3100
  • Fax:
Mailing address:
  • Phone: 920-454-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7165-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: