Individual
MISS TAMMIE EILEEN DEMICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1922 COUNTY RD. NN, ELKHORN, WI 53121
(262) 741-3630
(262) 743-1855
Mailing address
14 WILDWOOD CT UNIT D, WILLIAMS BAY, WI 53191-9647
(262) 245-0219
(262) 728-7129
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1812-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40850800
—
WI
Enumeration date
04/23/2007
Last updated
07/08/2007
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