Provider Demographics
NPI:1053688408
Name:HOPP, SHEILA ELICE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:ELICE
Last Name:HOPP
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 1:44 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-2956
Mailing Address - Country:US
Mailing Address - Phone:920-979-1002
Mailing Address - Fax:
Practice Address - Street 1:44 CONCORD DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-2956
Practice Address - Country:US
Practice Address - Phone:920-979-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI734-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant