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NPI Code Detail

MEDICARE: MRS. LINDA B. OTTERBACHER PTA

MEDICARE: MRS. LINDA B. OTTERBACHER PTA
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
1225200000XPhysical Therapy Assistant702-019WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356518260
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LINDA B. OTTERBACHER PTA
Provider Business Mailing Address
First Line : 19525 W NORTH AVE
Second Line :
City : BROOKFIELD
State : WI
Zip : 53045-4107
Country : US
Telephone Number : 262-780-3810
Fax Number : 262-780-3118
Provider Business Practice Location Address
First Line : 19525 W NORTH AVE
Second Line :
City : BROOKFIELD
State : WI
Zip : 53045-4107
Country : US
Telephone Number : 262-780-3810
Fax Number : 262-780-3118
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2008
Last Update Date : 09/18/2008

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