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General NPI Number Information
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NPI Number | 1790907392
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Entity Type | Individual
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Provider Name | LISA ANN LINDER C.O.T.A
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 115 E ARNDT ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-2461
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Country | US
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Telephone | 920-923-7054
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Fax | 920-923-7058
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Provider Business Mailing Address
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Address Line | 124 7TH ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-5085
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Country | US
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Telephone | 920-926-0179
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Fax | 920-926-0179
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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 | 1049-027
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License Number State | WI
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