Alane M Boutelle, COTA
Individual provider Active NPI Occupational Therapy Assistant · Verona, WI
NPI 1821389115 · NPPES record last updated Apr 21, 2011
Key facts
- NPI
- 1821389115
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 4767-027 (WI)
- Practice address
- 1100 E Verona Ave
Verona, WI 53593-8717 - Phone
- (608) 845-6601
- Fax
- (608) 845-1264
- NPI assigned
- Apr 21, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 4767-027 | WI | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 4767-027 | WI | Yes |
Addresses
Primary practice location
1100 E Verona Ave
Verona, WI 53593-8717
Mailing address
2448 S 102ND St
Suite # 340
Milwaukee, WI 53227-2466
Phone (414) 329-2500
Other providers in Verona, WI
- Blue Skies Pediatric Dentistry
- Dana Sue Bohrer
- Gary Bongey
- Kelly J Borelli
- Amanda Janssen Borleske
- Claire Boyce
- Joseph Hugh Boysen
- Loyda E Braithwaite
- Maryanne K Brandt
- Madeleine Emily Swenson Braun
All providers in Verona, 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 Apr 21, 2011. 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.