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General NPI Number Information
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NPI Number | 1134457427
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Entity Type | Individual
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Provider Name | ROSE BAVLNKA OTR
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Gender | Female
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | W202N10223 LANNON RD
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City | GERMANTOWN
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State | WI
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Zip | 53022-9545
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Country | US
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Telephone | 262-366-9088
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Fax |
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Provider Business Mailing Address
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Address Line | W202N10223 LANNON RD
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City | GERMANTOWN
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State | WI
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Zip | 53022-9545
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Country | US
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Telephone | 262-366-9088
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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 | 1036-26
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License Number State | WI
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