Individual
MR. PETER ANDREW BOEHNLEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1640 SHAWANO AVE, GREEN BAY, WI 54303-3214
(920) 499-5177
Mailing address
3151 WHITE BIRCH ST, KAUKAUNA, WI 54130-3938
(920) 766-3918
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
421-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8484097171
—
WI
Enumeration date
04/11/2008
Last updated
04/11/2008
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