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General NPI Number Information
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NPI Number | 1194971424
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Entity Type | Individual
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Provider Name | SU-ANNE BARRETT COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 209 WILDERNESS VIEW DR
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City | MARSHFIELD
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State | WI
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Zip | 54449-8357
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Country | US
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Telephone | 877-823-8357
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Fax |
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Provider Business Mailing Address
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Address Line | 4739 WILDERNESS LN
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City | HARSHAW
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State | WI
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Zip | 54529-9631
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Country | US
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Telephone | 309-212-3723
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057002858
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5346-27
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 057002858
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License Number State | IL
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