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General NPI Number Information
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NPI Number | 1588297188
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Entity Type | Individual
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Provider Name | NICOLE WEGGEN OTR
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Gender | Female
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | W175N11117 STONEWOOD DR STE 100
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City | GERMANTOWN
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State | WI
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Zip | 53022-6505
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Country | US
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Telephone | 262-227-8196
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Fax |
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Provider Business Mailing Address
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Address Line | 9112 W CENTER ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-4642
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Country | US
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Telephone | 262-349-3000
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 6508-26
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License Number State | WI
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