Individual
TAISHA DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
105565
MN
225X00000X
Occupational Therapist
Primary
6415
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477207405
—
WI
Enumeration date
02/08/2022
Last updated
10/19/2023
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