MEDICARE: MRS. LINDA LOUISE LEUPOLD 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
1	224Z00000X	Occupational Therapy Assistant	912-027	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972604296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA LOUISE LEUPOLD C.O.T.A.

Provider Business Mailing Address
First Line	:	15526 ROSECRANS RD
Second Line	:
City	:	MARIBEL
State	:	WI
Zip	:	54227-9711
Country	:	US
Telephone Number	:	920-863-6356
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 CURRY LN
Second Line	:	NEW CURATIVE REHABILITATION
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5857
Country	:	US
Telephone Number	:	920-468-9129
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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