Pamela Wayne, COTA

Individual provider Active NPI Occupational Therapy Assistant · Cornell, WI

NPI 1982885141 · NPPES record last updated Nov 16, 2007

Key facts

NPI
1982885141
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
4573-027 (WI)
Practice address
320 N 7TH St
Cornell, WI 54732-8120
Phone
(715) 239-0440
Fax
(715) 239-6608
NPI assigned
Nov 16, 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

LicenseStateTypeSpecialty
4573-027WIMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 4573-027 WI Yes

Addresses

Primary practice location

320 N 7TH St
Cornell, WI 54732-8120

Mailing address

320 N 7TH St
Cornell, WI 54732-8120
Phone (715) 239-0440

Other providers in Cornell, WI

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

Sources for this page

Verify at the official NPI Registry.