Individual
MRS. JEAN MARIE OTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
825 WESTERN AVE, COLUMBUS, WI 53925-1675
(920) 623-2520
(920) 623-9236
Mailing address
825 WESTERN AVE, COLUMBUS, WI 53925-1675
(920) 623-2520
(920) 623-9236
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1039-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40816800
—
WI
Enumeration date
04/07/2008
Last updated
04/07/2008
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