Provider Demographics
NPI:1053587980
Name:OHERRON, GENEVIEVE K (PT)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:K
Last Name:OHERRON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4981 DUCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HELENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53137-9617
Mailing Address - Country:US
Mailing Address - Phone:262-593-2511
Mailing Address - Fax:
Practice Address - Street 1:N4981 DUCK CREEK RD
Practice Address - Street 2:
Practice Address - City:HELENVILLE
Practice Address - State:WI
Practice Address - Zip Code:53137-9617
Practice Address - Country:US
Practice Address - Phone:262-593-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4238-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40195000Medicaid