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Individual

MRS. DIANNA WITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
1351 WISCONSIN RIVER DR, PORT EDWARDS, WI 54469-1041
(715) 885-8300
Mailing address
1241 3RD ST, PORT EDWARDS, WI 54469-1008
(715) 887-2655

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
794-027
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40719800
WI
Enumeration date
11/12/2007
Last updated
11/12/2007
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