Basic Information
| Provider Information | |||||||||
| NPI: | 1942238639 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MARCHERT-EATON | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | W239N1812 ROCKWOOD DR STE 100 | ||||||||
| Address2: | PROHEALTH CARE MEDICAL ASSOCIATES INC. | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531881113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625230310 | ||||||||
| FaxNumber: | 2625329587 | ||||||||
| Practice Location | |||||||||
| Address1: | W239N1812 ROCKWOOD DR STE 100 | ||||||||
| Address2: | PROHEALTH CARE MEDICAL ASSOCIATES INC. | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531881113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625230310 | ||||||||
| FaxNumber: | 2625329587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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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 | 225X00000X | 2643 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 40814400 | 05 | WI | MEDICAID |