Individual
MS. LISA KAY NIKULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.O.T.A.
Contact information
Practice address
317 KNUTSON DR, MADISON, WI 53704-1133
(608) 310-9379
Mailing address
317 KNUTSON DR, MADISON, WI 53704-1133
(608) 310-9379
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
54-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40888500
—
WI
01
—
54-027
STATE LICENSURE
WI
Enumeration date
09/20/2006
Last updated
07/08/2007
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