Provider Demographics
NPI:1972159705
Name:RICH, JOAN M
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:RICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:M
Other - Last Name:HERREID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3656 MALL DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7634
Mailing Address - Country:US
Mailing Address - Phone:715-552-1035
Mailing Address - Fax:715-552-4567
Practice Address - Street 1:3656 MALL DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7634
Practice Address - Country:US
Practice Address - Phone:715-552-1035
Practice Address - Fax:715-552-4567
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI522-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist