MEDICARE: WEST BEND CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1124328232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST BEND CLINIC, INC.

Provider Business Mailing Address
First Line	:	1700 W PARADISE DR
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095
Country	:	US
Telephone Number	:	262-334-3451
Fax Number	:

Provider Business Practice Location Address
First Line	:	W227 N16857 TILLIE LAKE COURT
Second Line	:
City	:	JACKSON
State	:	WI
Zip	:	53037-9000
Country	:	US
Telephone Number	:	262-365-6170
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JAMES BROWNE
Credential	:
Telephone Number	:	262-306-6536

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	10/25/2010

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Directions to “WEST BEND CLINIC, INC. ” Practice Location

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