Individual
ANN LOUISE PRUYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
828 E AZALEA TER, BELOIT, WI 53511-1606
(608) 290-4584
(608) 362-6065
Mailing address
828 E AZALEA TER, BELOIT, WI 53511-1606
(608) 290-4584
(608) 362-6065
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
056-000372
IL
225X00000X
Occupational Therapist
Primary
2095-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40904200
—
WI
01
—
P01085357
RR MEDICARE
WI
Enumeration date
07/29/2005
Last updated
04/01/2013
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