Colleen Margaret Boissonneault, COTA
Individual provider Active NPI Occupational Therapy Assistant · Hudson, WI
NPI 1104924042 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1104924042
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 1919 (WI)
- Practice address
- 2705 Enloe St
Hudson, WI 54016-8173 - Phone
- (715) 386-2128
- Fax
- (715) 386-6119
- NPI assigned
- Sep 21, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1919 | WI | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 1919 | WI | Yes |
Addresses
Primary practice location
2705 Enloe St
Hudson, WI 54016-8173
Mailing address
203 W Elm St
Roberts, WI 54023-9714
Phone (715) 254-9364
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40881100 | Medicaid | WI |
Other names
- Colleen Margaret Johnson
Other providers in Hudson, WI
- Jessica Blackford
- Jaime Lee Blechschmidt Adomaitis
- Larry Dean Bloom
- Jessica Lee Boettger
- Haley Lynn Bohl
- Susan Bopray
- Kaitlyn Miranda Borgerding
- Valerie Jayne Both
- Taylor Lauren Bowker
- Sloan Kennedy Liu Bozosi
All providers in Hudson, WI · Occupational Therapy Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.