Individual
MR. JASON WILLIAM DOZARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.O.T.A
Contact information
Practice address
7212 W LAFAYETTE PL, MEQUON, WI 53092-1595
(262) 643-4230
Mailing address
7212 W LAFAYETTE PL, MEQUON, WI 53092-1595
(262) 643-4230
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5143-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5143-27
OCCUAPATIONAL THERAPISTS AFFILIATED CREDENTIALING BOARD
WI
Enumeration date
04/07/2015
Last updated
04/07/2015
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