Provider Demographics
NPI:1023176534
Name:HOUTLER, BRUCE H (OTR)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:H
Last Name:HOUTLER
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 1:1414 JEFFERSON ST
Mailing Address - Street 2:REHAB SERVICES
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1503
Mailing Address - Country:US
Mailing Address - Phone:608-356-1400
Mailing Address - Fax:608-356-1448
Practice Address - Street 1:1414 JEFFERSON ST
Practice Address - Street 2:REHAB SERVICES
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1503
Practice Address - Country:US
Practice Address - Phone:608-356-1400
Practice Address - Fax:608-356-1448
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1485-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist