Provider Demographics
NPI:1154564391
Name:NISCHKE, ANNE MALM (OTR/L)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MALM
Last Name:NISCHKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MALM
Other - Last Name:NISCHKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-0567
Mailing Address - Country:US
Mailing Address - Phone:715-630-7967
Mailing Address - Fax:
Practice Address - Street 1:516 6TH AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1510
Practice Address - Country:US
Practice Address - Phone:715-630-7967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4749-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist