Provider Demographics
NPI:1588761258
Name:RUEGER, THERESA LYNN (COTA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:RUEGER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-1579
Mailing Address - Country:US
Mailing Address - Phone:920-379-2389
Mailing Address - Fax:
Practice Address - Street 1:244 N MACY ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3362
Practice Address - Country:US
Practice Address - Phone:920-926-0050
Practice Address - Fax:920-921-0819
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1346-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant