Healthcare Provider Details

I. General information

NPI: 1861614208
Provider Name (Legal Business Name): RENITA J FLOOD OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 ASH ST
SPOONER WI
54801-1201
US

IV. Provider business mailing address

1075 COUNTY HIGHWAY B
BRULE WI
54820-9050
US

V. Phone/Fax

Practice location:
  • Phone: 715-635-2111
  • Fax: 715-635-8674
Mailing address:
  • Phone: 715-372-5094
  • Fax: 715-635-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2715-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: