Individual
MS. LORI J PACZKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
425 SUMMIT ST, WILD ROSE, WI 54984-6804
(920) 622-3750
(920) 622-3752
Mailing address
212 DOUGLAS AVE, MONTELLO, WI 53949-9322
(608) 369-0004
(920) 622-3752
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4679-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992937932
—
WI
Enumeration date
08/09/2009
Last updated
11/02/2012
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