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General NPI Number Information
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NPI Number | 1558298521
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Entity Type | Individual
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Provider Name | CONSTANCE J WIEDMEYER
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Gender | Female
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 209 WAINWRIGHT AVE
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City | BURLINGTON
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State | WI
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Zip | 53105-2269
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Country | US
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Telephone | 262-763-0210
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 S 96TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53214-2608
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Country | US
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Telephone | 414-322-5083
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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