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General NPI Number Information
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NPI Number | 1790935716
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Entity Type | Organization
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Legal Business Name | RIVERWIND THERAPEUTICS, LLC
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 828 E AZALEA TER
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City | BELOIT
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State | WI
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Zip | 53511-1606
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Country | US
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Telephone | 608-290-4584
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Fax | 608-362-6065
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Provider Business Mailing Address
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Address Line | 828 E AZALEA TER
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City | BELOIT
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State | WI
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Zip | 53511-1606
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Country | US
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Telephone | 608-290-4584
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Fax | 608-362-6065
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Authorized Official
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Title or Position | OWNER
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Name | ANN PRUYNE
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Credential | MS, OTR
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Telephone | 608-290-4584
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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 | 2095-026
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License Number State | WI
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