Provider Demographics
NPI:1174905087
Name:AEGIS THERAPIES
Entity type:Organization
Organization Name:AEGIS THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:715-523-2277
Mailing Address - Street 1:900 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1936
Mailing Address - Country:US
Mailing Address - Phone:715-523-2277
Mailing Address - Fax:
Practice Address - Street 1:900 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1936
Practice Address - Country:US
Practice Address - Phone:715-523-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1994-026314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility