Individual
MS. TRACEY JOANNE SHAUGHNESSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
407 N 8TH ST, MOUNT HOREB, WI 53572
(608) 437-9626
(608) 437-9604
Mailing address
412 MELODY LANE, VERONA, WI 53593
(608) 845-5014
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
443027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40646000
—
WI
Enumeration date
06/07/2007
Last updated
07/08/2007
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