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NPI Code Detail

MEDICARE: SALLY B MERGENDAHL OT

MEDICARE: SALLY B MERGENDAHL OT
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 Therapist417-26WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1417-26OTHERWIWI STATE LIC

General Provider Information

NPI Number : 1508131137
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY B MERGENDAHL OT
Provider Business Mailing Address
First Line : 5412 US HIGHWAY 10 E
Second Line :
City : STEVENS POINT
State : WI
Zip : 54482-8559
Country : US
Telephone Number : 715-346-5243
Fax Number :
Provider Business Practice Location Address
First Line : 5412 US HIGHWAY 10 E
Second Line :
City : STEVENS POINT
State : WI
Zip : 54482-8559
Country : US
Telephone Number : 715-346-5243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2012
Last Update Date : 03/15/2012

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Directions to “ SALLY B MERGENDAHL OT” Practice Location

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