Individual
AMANDA BUSSAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
198 COUNTY ROAD DF, JUNEAU, WI 53039-9515
(920) 386-3472
Mailing address
452 N BIRDSEY ST, COLUMBUS, WI 53925-1128
(608) 444-8224
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5700-27
WI
Other
Enumeration date
06/16/2020
Last updated
06/16/2020
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