Provider Demographics
NPI:1104436658
Name:FUNCTIONAL DESIGNS & SOLUTIONS LLC
Entity type:Organization
Organization Name:FUNCTIONAL DESIGNS & SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:SLETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-408-8692
Mailing Address - Street 1:N9581 FENSKE ROAD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:WI
Mailing Address - Zip Code:53926
Mailing Address - Country:US
Mailing Address - Phone:608-408-8692
Mailing Address - Fax:
Practice Address - Street 1:N9581 FENSKE ROAD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:WI
Practice Address - Zip Code:53926
Practice Address - Country:US
Practice Address - Phone:608-408-8692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-08
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental ModificationGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental ModificationGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty