Mary Ellen Weidner-Ruediger, OTR
Individual provider Active NPI Occupational Therapist · Redgranite, WI
NPI 1851573596 · NPPES record last updated Dec 10, 2012
Key facts
- NPI
- 1851573596
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 1547-026 (WI)
- Practice address
- W5004 Beechnut Avenue
Redgranite, WI 54970-6904 - Phone
- (920) 470-8442
- NPI assigned
- Dec 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1547-026 | WI | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1547-026 | WI | Yes |
Addresses
Primary practice location
W5004 Beechnut Avenue
Redgranite, WI 54970-6904
Mailing address
W5004 Beechnut Avenue
Redgranite, WI 54970-6904
Phone (920) 470-8442
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40577400 | Medicaid | WI |
Other providers in Redgranite, WI
- Charles Albert Huibregtse
- Lori Augusta Larsen
- Craig Dennis Maskil
- Renee Schmidt
- Thedacare Medical Center - Berlin, Inc.
- Wildcard Collective, LLC
All providers in Redgranite, WI · Occupational Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.