Tammie Eileen Demicco, COTA
Individual provider Active NPI Occupational Therapy Assistant · Elkhorn, WI
NPI 1245458140 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1245458140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 1812-027 (WI)
- Practice address
- 1922 County Rd. NN
Elkhorn, WI 53121 - Phone
- (262) 741-3630
- Fax
- (262) 743-1855
- NPI assigned
- Apr 23, 2007
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 1812-027 | WI | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 1812-027 | WI | Yes |
Addresses
Primary practice location
1922 County Rd. NN
Elkhorn, WI 53121
Mailing address
14 Wildwood CT Unit D
Williams Bay, WI 53191-9647
Phone (262) 245-0219
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40850800 | Medicaid | WI |
Other providers in Elkhorn, WI
- Matthew Alan Dahlgren
- Heather Dawn Dalton
- Tonya Jean David
- Lora Renee Defranco
- Matthew Degroot
- Peter S Diamond
- Jessica Christine Doherty
- Liza Jayne Drake
- Amanda Marie Duckworth
- E F Chiropractic Inc
All providers in Elkhorn, 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 8, 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.