1841411303 NPI number — MS. CHERYL ANN STAEHLER P.T.A.

Table of content: MS. CHERYL ANN STAEHLER P.T.A. (NPI 1841411303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841411303 NPI number — MS. CHERYL ANN STAEHLER P.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAEHLER
Provider First Name:
CHERYL
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAMPE
Provider Other First Name:
CHERYL
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841411303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 MARINA CT UNIT 32
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53185-4477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-210-6288
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8633 32ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53142-5187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-694-8300
Provider Business Practice Location Address Fax Number:
262-694-9125
Provider Enumeration Date:
05/01/2007

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: 225200000X , with the licence number:  334-019 , 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)

  • Identifier: 40377800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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