Healthcare Provider Details

I. General information

NPI: 1508078312
Provider Name (Legal Business Name): SUE ANN VOLLMER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 HOOVER ST
NEW HOLSTEIN WI
53061-1636
US

IV. Provider business mailing address

N8011 FAIRFIELD DR
FOND DU LAC WI
54935-7813
US

V. Phone/Fax

Practice location:
  • Phone: 920-898-5627
  • Fax: 920-898-1375
Mailing address:
  • Phone: 920-923-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3392-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: