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General NPI Number Information
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NPI Number | 1689375834
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Entity Type | Individual
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Provider Name | CLAIRE INGISH PTA
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Gender | Female
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 205 UNITED WAY
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City | FREDERIC
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State | WI
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Zip | 54837-8938
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Country | US
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Telephone | 262-483-9322
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Fax |
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Provider Business Mailing Address
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Address Line | 142 LAUREL DR N
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City | WEST BEND
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State | WI
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Zip | 53095-5005
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Country | US
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Telephone | 262-483-9322
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3326-19
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License Number State | WI
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