MEDICARE: JEAN MARIE DEPREY OTD

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	103K00000X	Behavior Analyst
2	225X00000X	Occupational Therapist	7062-26	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1303287	OTHER	MA	MBHP
2	042611055	OTHER	MA	TAX ID
3	0000023532	OTHER	MA	BMC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	99618201	OTHER	MA	NETWORK HEALTH
6	1004745	OTHER	MA	NHP
7	M18633	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1285985150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN MARIE DEPREY OTD

Provider Business Mailing Address
First Line	:	200 N PATRICK BLVD STE 250
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-5883
Country	:	US
Telephone Number	:	414-865-0398
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 N PATRICK BLVD STE 250
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-5883
Country	:	US
Telephone Number	:	414-865-0398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	02/21/2023

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Directions to “ JEAN MARIE DEPREY OTD” Practice Location

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