Provider Demographics
NPI:1972713006
Name:REIFF, ALBERT JOHN (OTR)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:JOHN
Last Name:REIFF
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HAZEL GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53811-9559
Mailing Address - Country:US
Mailing Address - Phone:608-854-2257
Mailing Address - Fax:
Practice Address - Street 1:2774 UNIVERSITY AVE
Practice Address - Street 2:SUITE F
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-5669
Practice Address - Country:US
Practice Address - Phone:563-557-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13014Medicare UPIN