Healthcare Provider Details

I. General information

NPI: 1871249813
Provider Name (Legal Business Name): JILL RAHN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL WEISENSEL

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CLARK ST
LODI WI
53555-1010
US

IV. Provider business mailing address

3200 COUNTY ROAD T
MADISON WI
53718-6435
US

V. Phone/Fax

Practice location:
  • Phone: 608-592-3241
  • Fax:
Mailing address:
  • Phone: 608-245-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: