Provider Demographics
NPI:1730331281
Name:HIGGINS, CAROL ANN (PTA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 RUFFED CT
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5232
Mailing Address - Country:US
Mailing Address - Phone:920-469-0781
Mailing Address - Fax:
Practice Address - Street 1:316 E 14TH ST
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-3304
Practice Address - Country:US
Practice Address - Phone:920-766-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI277-019314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility