Basic Information
| Provider Information | |||||||||
| NPI: | 1093085680 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KOHLS | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | ALISSA | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 N, MAPLE | ||||||||
| Address2: | ELLSWORTH CARE CENTER | ||||||||
| City: | ELLSWORTH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54011 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 403 N MAPLE ST | ||||||||
| Address2: | ELLSWORTH CARE CENTER | ||||||||
| City: | ELLSWORTH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152735821 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2012 | ||||||||
| LastUpdateDate: | 01/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 840-27 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.