Provider Demographics
NPI:1215292982
Name:SIEVERT, VANESSA M
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:M
Last Name:SIEVERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 STEPHANIE CT
Mailing Address - Street 2:
Mailing Address - City:BLACK EARTH
Mailing Address - State:WI
Mailing Address - Zip Code:53515-9520
Mailing Address - Country:US
Mailing Address - Phone:608-298-8087
Mailing Address - Fax:
Practice Address - Street 1:2043 STEPHANIE CT
Practice Address - Street 2:
Practice Address - City:BLACK EARTH
Practice Address - State:WI
Practice Address - Zip Code:53515-9520
Practice Address - Country:US
Practice Address - Phone:608-298-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5209-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist