Provider Demographics
NPI:1235519885
Name:HAMMEN, RENEE (COTA)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:HAMMEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:GRATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:500 S OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7944
Mailing Address - Country:US
Mailing Address - Phone:920-628-9249
Mailing Address - Fax:
Practice Address - Street 1:500 S OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7944
Practice Address - Country:US
Practice Address - Phone:920-628-9249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5077-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1023065356Medicaid
WI1023065356Medicare UPIN
WI1023065356Medicare Oscar/Certification
WI1023065356Medicaid
WI1023065356Medicare NSC