Individual
MR. ERIC KEITH TISCHENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
112 E 5TH AVE, ANTIGO, WI 54409-2710
(715) 623-9449
Mailing address
N1021 US HIGHWAY 45 S, ANTIGO, WI 54409-8856
(715) 623-3363
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
857-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40746000
—
WI
Enumeration date
03/14/2007
Last updated
07/09/2007
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