Healthcare Provider Details

I. General information

NPI: 1154564482
Provider Name (Legal Business Name): HANDISHOP INDUSTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N SUPERIOR AVE
TOMAH WI
54660-1131
US

IV. Provider business mailing address

1411 N SUPERIOR AVE
TOMAH WI
54660-1131
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-3289
  • Fax: 608-372-0770
Mailing address:
  • Phone: 608-372-3289
  • Fax: 608-372-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: PATTY CLARK
Title or Position: BUSINESS MANAGER
Credential:
Phone: 608-372-3289