Provider Demographics
NPI:1528122926
Name:BRESSER, PATTY ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:PATTY
Middle Name:ANN
Last Name:BRESSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MR
Other - First Name:PAT
Other - Middle Name:ANN
Other - Last Name:BRESSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:9 BEVERLY CT
Mailing Address - Street 2:
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-2104
Mailing Address - Country:US
Mailing Address - Phone:920-324-3991
Mailing Address - Fax:
Practice Address - Street 1:2300 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-9137
Practice Address - Country:US
Practice Address - Phone:920-233-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3579-024174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist