Provider Demographics
NPI:1083881403
Name:NELSON, ANN (COTA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:NELSON
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 1:4390 BRICKYARD LN
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-2350
Mailing Address - Country:US
Mailing Address - Phone:608-788-8453
Mailing Address - Fax:
Practice Address - Street 1:2501 SHELBY RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-8037
Practice Address - Country:US
Practice Address - Phone:608-788-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2001-027224Z00000X
MN201477224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant