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General NPI Number Information
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NPI Number | 1861694127
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Entity Type | Individual
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Provider Name | ANTONIA LEE BLUEMKE OTR
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 1222 E WOODLAND AVE
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City | BARRON
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State | WI
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Zip | 54812
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Country | US
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Telephone | 715-537-9905
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Fax |
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Provider Business Mailing Address
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Address Line | 200 1ST ST SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0001
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Country | US
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Telephone | 715-838-5222
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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 | 102400
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License Number State | MN
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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 | 3194-26
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License Number State | WI
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