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General NPI Number Information
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NPI Number | 1093877169
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Entity Type | Individual
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Provider Name | MARY J EWERS OTR
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 106 SOUTH HOLMEN DR, SUITE 2 ACHIEVE SOLUTIONS, INC.
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City | HOLMEN
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State | WI
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Zip | 54636
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Country | US
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Telephone | 608-526-9888
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Fax |
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Provider Business Mailing Address
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Address Line | 3027 SCARLETT DR
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City | LA CROSSE
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State | WI
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Zip | 54601-8104
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1050810
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License Number State | WI
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