Individual
MISS KAWANA MONIQUE MOMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2525 N MAYFAIR RD STE 200, WAUWATOSA, WI 53226-1403
(414) 476-8183
(414) 476-8472
Mailing address
5418 N 53RD ST, MILWAUKEE, WI 53218-3321
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1348-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21280000
—
WI
01
—
3917061314
GROUP TAX ID
WI
05
—
40879900 (35/114)
—
WI
Enumeration date
07/22/2006
Last updated
07/21/2022
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