Provider Demographics
NPI:1164804951
Name:WASCHBISCH, SYDNIE HOLLAN PARISH (COTA)
Entity Type:Individual
Prefix:
First Name:SYDNIE
Middle Name:HOLLAN PARISH
Last Name:WASCHBISCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SYDNIE
Other - Middle Name:
Other - Last Name:PARISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:2927 S FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6498
Mailing Address - Country:US
Mailing Address - Phone:608-819-6394
Mailing Address - Fax:608-204-6183
Practice Address - Street 1:2927 S FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-6498
Practice Address - Country:US
Practice Address - Phone:608-819-6394
Practice Address - Fax:608-204-6183
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5185-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant