Individual
JENNIE LAUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
559 MICHIGAN ST, OMRO, WI 54963-1254
(719) 258-0072
Mailing address
559 MICHIGAN ST, OMRO, WI 54963-1254
(719) 258-0072
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5767-27
WI
313M00000X
Nursing Facility/Intermediate Care Facility
OTA0000500
CO
Other
Enumeration date
03/23/2016
Last updated
05/25/2021
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