Provider Demographics
NPI:1699014571
Name:MONROE CLINIC
Entity type:Organization
Organization Name:MONROE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED OCCUPATIONAL THERAPY ASSI
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARON
Authorized Official - Suffix:
Authorized Official - Credentials:L/COTA
Authorized Official - Phone:608-609-0521
Mailing Address - Street 1:2714 YAHARA RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-3369
Mailing Address - Country:US
Mailing Address - Phone:608-609-0521
Mailing Address - Fax:
Practice Address - Street 1:2714 YAHARA RD
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-3369
Practice Address - Country:US
Practice Address - Phone:608-609-0521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4874-27282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural