Healthcare Provider Details

I. General information

NPI: 1750694311
Provider Name (Legal Business Name): ANDREA JOY WAHHAB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 9TH ST N
PARK FALLS WI
54552-1384
US

IV. Provider business mailing address

420 9TH ST N
PARK FALLS WI
54552-1384
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-2474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4910-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: