=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184992133
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA LYN POND OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2011
-----------------------------------------------------
Last Update Date | 12/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 660 E BIRCH AVE
-----------------------------------------------------
City | BARRON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54812-9130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-537-5643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | E6298 COUNTY ROAD V
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54763-9432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-949-0031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 3446-26
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------