Provider Demographics
NPI:1285177287
Name:FIDLER, RUBIE KIRSTEN
Entity type:Individual
Prefix:
First Name:RUBIE
Middle Name:KIRSTEN
Last Name:FIDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RUBIE
Other - Middle Name:K
Other - Last Name:KEYZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1711 BASSETT PL
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-5479
Mailing Address - Country:US
Mailing Address - Phone:715-572-8250
Mailing Address - Fax:
Practice Address - Street 1:500 E VETERANS ST
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3105
Practice Address - Country:US
Practice Address - Phone:715-424-4682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5959-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist