Dyan C Badora, C.O.T.A

Individual provider Active NPI Occupational Therapy Assistant · Greendale, WI

NPI 1144488404 · NPPES record last updated May 22, 2008

Key facts

NPI
1144488404
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
570-027 (WI)
Practice address
5404 W Loomis Rd
Greendale, WI 53129-1411
Phone
(414) 421-0088
NPI assigned
May 22, 2008
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)
No

State licenses

LicenseStateTypeSpecialty
570-027WIMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 570-027 WI Yes

Addresses

Primary practice location

5404 W Loomis Rd
Greendale, WI 53129-1411

Mailing address

5404 W Loomis Rd
Greendale, WI 53129-1411
Phone (414) 421-0088

Other providers in Greendale, WI

All providers in Greendale, WI · Occupational Therapy Assistant in Wisconsin

Sources for this page

Verify at the official NPI Registry.