Individual
AMY EVENSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2575 7TH ST S, LA CROSSE, WI 54601-5249
(608) 775-8251
Mailing address
N496 COUNTY ROAD PI, COON VALLEY, WI 54623-9374
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
1489-027
WI
225X00000X
Occupational Therapist
Primary
4511-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1489-027
COTA LICENSE
WI
Enumeration date
12/15/2006
Last updated
05/14/2008
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