Provider Demographics
NPI:1023145596
Name:PATTON, MARY BETH (OTR)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:PATTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2757
Mailing Address - Country:US
Mailing Address - Phone:414-257-1938
Mailing Address - Fax:262-257-1949
Practice Address - Street 1:3415 N 127TH ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3117
Practice Address - Country:US
Practice Address - Phone:262-781-8144
Practice Address - Fax:262-781-8552
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI892026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist