Basic Information
| Provider Information | |||||||||
| NPI: | 1548412299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANDERSEN KAUFMAN | ||||||||
| OtherFirstName: | DONNA | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 354 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OREGON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535751426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088353535 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 354 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OREGON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535751426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088353535 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2008 | ||||||||
| LastUpdateDate: | 10/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 946-019 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.