Basic Information
| Provider Information | |||||||||
| NPI: | 1508013046 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOTTSCHALK | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4325 NAKOMA ROAD | ||||||||
| Address2: | SUNNY HILL HEALTH CARE CENTER | ||||||||
| City: | MADISON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 53711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082717321 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4325 NAKOMA ROAD | ||||||||
| Address2: | SUNNY HILL HEALTH CARE CENTER | ||||||||
| City: | MADISON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 53711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082717321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2008 | ||||||||
| LastUpdateDate: | 08/27/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1860-027 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.