MEDICARE: MRS. WIEBKE PAPENFUS 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
1	225X00000X	Occupational Therapist	5201005818	MI

General Provider Information

NPI Number	:	1417961368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WIEBKE PAPENFUS OTR

Provider Business Mailing Address
First Line	:	42615 GARFIELD ROAD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038
Country	:	US
Telephone Number	:	586-412-2846
Fax Number	:	586-412-7087

Provider Business Practice Location Address
First Line	:	5832 NORTH LAPEER RD
Second Line	:	FULL CIRCLE PHYSICAL THERAPY SUITE A
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461
Country	:	US
Telephone Number	:	810-793-5282
Fax Number	:	810-793-5281

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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