Provider Demographics
NPI:1386918480
Name:WERTENBERGER, WILLIAM (MS/OTR)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:WERTENBERGER
Suffix:
Gender:M
Credentials:MS/OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51730 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-9796
Mailing Address - Country:US
Mailing Address - Phone:906-482-9033
Mailing Address - Fax:
Practice Address - Street 1:901 W MEM DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-2475
Practice Address - Country:US
Practice Address - Phone:906-482-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002490225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist