Healthcare Provider Details

I. General information

NPI: 1629241674
Provider Name (Legal Business Name): CONSTANCE BEDNAR OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5595 COUNTY ROAD Z
WEST BEND WI
53095-9224
US

IV. Provider business mailing address

5595 COUNTY ROAD Z
WEST BEND WI
53095-9224
US

V. Phone/Fax

Practice location:
  • Phone: 262-306-2100
  • Fax:
Mailing address:
  • Phone: 262-306-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number67026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: