Provider Demographics
NPI:1063685469
Name:MUELLER, SHELLY R (COTA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:R
Last Name:MUELLER
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 1:1414 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1503
Mailing Address - Country:US
Mailing Address - Phone:608-356-4838
Mailing Address - Fax:608-356-5441
Practice Address - Street 1:1414 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1503
Practice Address - Country:US
Practice Address - Phone:608-356-4838
Practice Address - Fax:608-356-5441
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant