Healthcare Provider Details

I. General information

NPI: 1083370647
Provider Name (Legal Business Name): JOANNA M MCCAULEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E VETERANS ST
TOMAH WI
54660-3105
US

IV. Provider business mailing address

W10231 COUNTY RD PP
ELROY WI
53929
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-3971
  • Fax: 608-372-1184
Mailing address:
  • Phone: 262-646-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2100-028
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: