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NPI Code Detail

MEDICARE: ANN V. JOHN OTR

MEDICARE: ANN V. JOHN OTR
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
1225X00000XOccupational Therapist1166WI
2225XE1200XErgonomics Occupational Therapist1166WI
3225XH1200XHand Occupational Therapist1166WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3391550272010OTHERWIBCBS GROUP BILLING NUMBER

General Provider Information

NPI Number : 1285823161
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN V. JOHN OTR
Provider Business Mailing Address
First Line : 4922 COLUMBIA RD
Second Line :
City : CEDARBURG
State : WI
Zip : 53012-9188
Country : US
Telephone Number : 262-377-4077
Fax Number : 262-377-7358
Provider Business Practice Location Address
First Line : 4922 COLUMBIA RD
Second Line :
City : CEDARBURG
State : WI
Zip : 53012-9188
Country : US
Telephone Number : 262-377-4077
Fax Number : 262-377-7358
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2007
Last Update Date : 10/17/2007

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