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General NPI Number Information
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NPI Number | 1548456148
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Entity Type | Organization
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Legal Business Name | THEDA CLARK HOSPITAL
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 130 2ND ST
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City | NEENAH
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State | WI
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Zip | 54956-2883
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Country | US
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Telephone | 920-729-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 130 2ND ST
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City | NEENAH
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State | WI
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Zip | 54956-2883
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Country | US
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Telephone | 920-729-3100
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | MRS. DAWN MARIE FORCEY
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Credential | PTA
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Telephone | 920-833-7508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 475-019
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License Number State | WI
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