Individual
TINA M AMUNDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
500 GRANT AVE, OMRO, WI 54963-1342
(920) 685-2755
Mailing address
721 MADISON AVE, OMRO, WI 54963-1629
(920) 685-0658
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
747-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40761400
—
WI
Enumeration date
10/15/2008
Last updated
08/29/2012
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