Healthcare Provider Details

I. General information

NPI: 1326432303
Provider Name (Legal Business Name): JOURNEYS OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 A J ALLEN CIR SUITE A1
WALES WI
53183-9542
US

IV. Provider business mailing address

543 A J ALLEN CIR SUITE A1
WALES WI
53183-9542
US

V. Phone/Fax

Practice location:
  • Phone: 262-968-2001
  • Fax: 262-347-3371
Mailing address:
  • Phone: 262-968-2001
  • Fax: 262-347-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2307-26
License Number StateWI

VIII. Authorized Official

Name: NATALIE C BLEDSTEIN
Title or Position: OWNER, OCCUPATIONAL THERAPIST
Credential: OTR, CST
Phone: 262-968-2001