Individual
EILEEN M FOSSUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
614 S ROCK AVE, VIROQUA, WI 54665-1936
(608) 637-2171
Mailing address
N1530 BREIDEL COULEE RD, LA CROSSE, WI 54601-2168
(608) 397-8368
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4813-27
WI
Other
Enumeration date
05/30/2018
Last updated
06/16/2018
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