Individual
MRS. TANYA RAE WILTZIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2300 WESTERN AVE, MANITOWOC, WI 54220-7253
(920) 320-4235
Mailing address
2509 N.12TH STREET, SHEBOYGAN, WI 53083-1871
(920) 889-8274
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2051-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41057700
—
WI
Enumeration date
03/14/2008
Last updated
10/22/2014
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