Provider Demographics
NPI:1548494032
Name:MARCHANT, JUDITH A (OT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:MARCHANT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:MARCHANT-HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:8700 W WATERTOWN PLANK RD
Mailing Address - Street 2:DEPT OF PLASTIC SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3595
Mailing Address - Country:US
Mailing Address - Phone:414-805-5440
Mailing Address - Fax:414-259-0901
Practice Address - Street 1:8700 W WATERTOWN PLANK RD
Practice Address - Street 2:DEPT OF PLASTIC SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3595
Practice Address - Country:US
Practice Address - Phone:414-805-5440
Practice Address - Fax:414-259-0901
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2485225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1548494032Medicaid
WI1548494032Medicaid
WI68086 0980Medicare PIN