Colleen Therese Wallace, COTA
Individual provider Active NPI Skilled Nursing Facility · Arpin, WI
NPI 1992043210 · NPPES record last updated Jan 21, 2013
Key facts
- NPI
- 1992043210
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 1032-27 (WI)
- Practice address
- 9286 Arpin Richfield Rd
Arpin, WI 54410-9514 - Phone
- (715) 897-4213
- NPI assigned
- Jan 21, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
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 |
|---|---|---|---|
| 1032-27 | WI | MD | Skilled Nursing Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NSH Marshfield LLC | Skilled Nursing Facility | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1032-27 | WI | Yes |
Addresses
Primary practice location
9286 Arpin Richfield Rd
Arpin, WI 54410-9514
Mailing address
9286 Arpin Richfield Rd
Arpin, WI 54410-9514
Phone (715) 897-4213
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1032-27 | Medicaid | WI |
Other providers in Arpin, WI
- James M McMahon
- Mobile Dental LLC
- Brad Pralle
- Valerie Rude
- Rebecca Gae Tamason
- Marie Helen Walsh
- Tara Jane Weiler
All providers in Arpin, WI · Skilled Nursing Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2013. 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.