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General NPI Number Information
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NPI Number | 1295003754
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Entity Type | Individual
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Provider Name | KARLA JEAN DRAVES C.O.T.A.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 2448 S 102ND ST SIUTE NUMBER 340
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City | MILWAUKEE
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State | WI
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Zip | 53227-2466
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Country | US
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Telephone | 414-329-2431
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Fax |
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Provider Business Mailing Address
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Address Line | 570 E AZALEA TER
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City | BELOIT
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State | WI
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Zip | 53511-1602
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Country | US
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Telephone |
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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 | 343-27
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License Number State | WI
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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 | 057001574
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License Number State | IL
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