Provider Demographics
NPI:1144567736
Name:KOSOSKI, PAMELA A (LAC, LMT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:A
Last Name:KOSOSKI
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 N LYNNDALE DR STE 1B
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3091
Mailing Address - Country:US
Mailing Address - Phone:920-422-4910
Mailing Address - Fax:920-358-7005
Practice Address - Street 1:1011 N LYNNDALE DR STE 1B
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3091
Practice Address - Country:US
Practice Address - Phone:920-422-4910
Practice Address - Fax:920-358-7005
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11973-146225700000X
WI937-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist