Healthcare Provider Details

I. General information

NPI: 1285785162
Provider Name (Legal Business Name): LINDA HURT O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 PINE RIDGE BLVD
WAUSAU WI
54401-4120
US

IV. Provider business mailing address

PO BOX 1008
WAUSAU WI
54402-1008
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2826
  • Fax:
Mailing address:
  • Phone: 715-847-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3476-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: