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General NPI Number Information
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NPI Number | 1699014571
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Entity Type | Organization
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Legal Business Name | MONROE CLINIC
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Dates
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Enumeration Date | 02/12/2013
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 2714 YAHARA RD
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City | STOUGHTON
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State | WI
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Zip | 53589-3369
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Country | US
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Telephone | 608-609-0521
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Fax |
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Provider Business Mailing Address
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Address Line | 2714 YAHARA RD
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City | STOUGHTON
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State | WI
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Zip | 53589-3369
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Country | US
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Telephone | 608-609-0521
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Fax |
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Authorized Official
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Title or Position | CERTIFIED OCCUPATIONAL THERAPY ASSI
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Name | MS. SUSAN W CARON
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Credential | L/COTA
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Telephone | 608-609-0521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 4874-27
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License Number State | WI
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