Erin S. Konichek, COTA

Individual provider Active NPI Occupational Therapy Assistant · Ladysmith, WI

NPI 1194069831 · NPPES record last updated Nov 19, 2012

Key facts

NPI
1194069831
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
4836-027 (WI)
Practice address
900 College Ave W
Ladysmith, WI 54848-2116
Phone
(715) 532-5561
Fax
(715) 532-5146
NPI assigned
Nov 19, 2012
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
4836-027WIMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 4836-027 WI Yes

Addresses

Primary practice location

900 College Ave W
Ladysmith, WI 54848-2116

Mailing address

900 College Ave W
Ladysmith, WI 54848-2116
Phone (715) 532-5561

Other providers in Ladysmith, WI

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

Sources for this page

Verify at the official NPI Registry.