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NPI Code Detail

MEDICARE: MELISSA MERTH C.O.T.A

MEDICARE: MELISSA MERTH C.O.T.A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant5029-27WI

General Provider Information

NPI Number : 1477987956
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA MERTH C.O.T.A
Provider Business Mailing Address
First Line : 2194 PIERCE SAINT CROIX RD
Second Line :
City : BALDWIN
State : WI
Zip : 54002-2800
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1505 ORRIN RD
Second Line :
City : PRESCOTT
State : WI
Zip : 54021-1074
Country : US
Telephone Number : 715-262-5661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2013
Last Update Date : 09/03/2013

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