Individual
IDA LYN STEVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2903 13TH ST, MONROE, WI 53566-2245
(608) 558-6032
Mailing address
2903 13TH ST, MONROE, WI 53566-2245
(608) 558-6032
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057003252
OCCUPATIONAL THERAPY ASSISTANT LISCENSE
IL
01
—
1902-27
OCCUPATIONAL THERAPY ASSISTANT LISCENSE
WI
Enumeration date
05/12/2008
Last updated
10/19/2020
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