Individual
JANE MARIE HERTEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
5798 S HWY T, DENMARK, WI 54208
(920) 863-6214
Mailing address
5798 S HWY T, DENMARK, WI 54208-9463
(920) 863-6214
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1568-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568-026
STATE OF WISCONSIN DEPARTMENT OF REGULATION AND LICENSING
WI
05
—
40529100
—
WI
Enumeration date
10/09/2008
Last updated
10/09/2008
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