Provider Demographics
NPI:1003305103
Name:KRAUSE, KASSANDRA (COTA)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 MOUNTAIN ASH LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-1166
Mailing Address - Country:US
Mailing Address - Phone:920-284-2082
Mailing Address - Fax:
Practice Address - Street 1:5625 SANDPIPER DR
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8974
Practice Address - Country:US
Practice Address - Phone:715-343-7376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5497-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant