Provider Demographics
NPI:1447302500
Name:COENEN, ANITA MARIE (ATC)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:MARIE
Last Name:COENEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 RED PINE DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-8367
Mailing Address - Country:US
Mailing Address - Phone:715-579-2575
Mailing Address - Fax:
Practice Address - Street 1:1200 OAKLEAF WAY STE A
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2245
Practice Address - Country:US
Practice Address - Phone:715-832-1400
Practice Address - Fax:715-832-4187
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer