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General NPI Number Information
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NPI Number | 1700390036
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Entity Type | Individual
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Provider Name | ANNE JONES WIERSGALLA OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2981 CAHILL MAIN APT 112
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City | FITCHBURG
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State | WI
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Zip | 53711-7156
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Country | US
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Telephone | 608-289-3995
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Fax |
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Provider Business Mailing Address
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Address Line | 2981 CAHILL MAIN APT 112
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City | FITCHBURG
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State | WI
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Zip | 53711-7156
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Country | US
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Telephone | 608-289-3995
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Fax | 608-527-1999
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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 | 056009955
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 6127-26
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License Number State | WI
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