Basic Information
| Provider Information | |||||||||
| NPI: | 1740794775 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VERFUERTH | ||||||||
| FirstName: | BECKY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10717 S RICHARD RD | ||||||||
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| City: | OAK CREEK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531547955 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1703 60TH ST | ||||||||
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| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531403986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626584125 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2017 | ||||||||
| LastUpdateDate: | 11/29/2017 | ||||||||
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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 | 224Z00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.