1437606373 NPI number — MRS. SHERRY LYNN REINSBACH OTA

Table of content: MRS. SHERRY LYNN REINSBACH OTA (NPI 1437606373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437606373 NPI number — MRS. SHERRY LYNN REINSBACH OTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REINSBACH
Provider First Name:
SHERRY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILSON
Provider Other First Name:
SHERRY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437606373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2759
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54912-2759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-830-5900
Provider Business Mailing Address Fax Number:
920-830-5910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54923-1243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-361-5538
Provider Business Practice Location Address Fax Number:
920-361-5499
Provider Enumeration Date:
09/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  4976 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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