MEDICARE: SHERRY THIEMER 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	225XM0800X	Mental Health Occupational Therapist	634-26	WI

General Provider Information

NPI Number	:	1669835542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY THIEMER OTR

Provider Business Mailing Address
First Line	:	1527 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2141
Country	:	US
Telephone Number	:	414-383-8921
Fax Number	:	414-383-9016

Provider Business Practice Location Address
First Line	:	1527 W. NATIONAL AVENUE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2141
Country	:	US
Telephone Number	:	414-383-8921
Fax Number	:	414-383-9016

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

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	03/30/2016

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