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NPI Code Detail

MEDICARE: ASHLEA WENNEKER MSOTR/L

MEDICARE: ASHLEA WENNEKER MSOTR/L
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 Therapist056009327IL

General Provider Information

NPI Number : 1720370752
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEA WENNEKER MSOTR/L
Provider Business Mailing Address
First Line : 804 STATE ST
Second Line : #5
City : QUINCY
State : IL
Zip : 62301-4968
Country : US
Telephone Number : 217-224-1750
Fax Number : 217-224-0403
Provider Business Practice Location Address
First Line : 804 STATE ST
Second Line : #5
City : QUINCY
State : IL
Zip : 62301-4968
Country : US
Telephone Number : 217-224-1750
Fax Number : 217-224-0403
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2011
Last Update Date : 05/10/2011

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Directions to “ ASHLEA WENNEKER MSOTR/L” Practice Location

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