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General NPI Number Information
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NPI Number | 1467635045
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Entity Type | Individual
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Provider Name | MARY LYNN RUELLE OT
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Gender | Female
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 709 SPRING VALLEY RD
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City | BURLINGTON
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State | WI
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Zip | 53105-7614
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Country | US
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Telephone | 262-971-9300
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Fax | 262-971-9301
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Provider Business Mailing Address
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Address Line | 709 SPRING VALLEY RD
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City | BURLINGTON
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State | WI
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Zip | 53105-7614
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Country | US
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Telephone | 262-971-9300
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Fax | 262-971-9301
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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 | 3607
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License Number State | WI
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