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General NPI Number Information
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NPI Number | 1467629907
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Entity Type | Organization
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Legal Business Name | J T SCHOOL DISTRICT 2
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 405 BISSELL STREET
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City | WHITE LAKE
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State | WI
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Zip | 54491-0067
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Country | US
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Telephone | 715-882-2361
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Fax | 715-882-2914
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Provider Business Mailing Address
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Address Line | PO BOX 67 405 BISSELL STREET
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City | WHITE LAKE
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State | WI
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Zip | 54491-0067
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Country | US
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Telephone | 715-882-2361
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Fax | 715-882-2914
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Authorized Official
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Title or Position | DIR OF SPECIAL EDUCATION
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Name | MRS. DEBORAH DOUGLAS WALL
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Credential | MSE
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Telephone | 715-882-2361
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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 | 065019
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 605019
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 079225
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License Number State | WI
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