Provider Demographics
NPI:1205034303
Name:KANE, TANIA LOUISE (COTA)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:LOUISE
Last Name:KANE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:TANIA
Other - Middle Name:LOUISE
Other - Last Name:RISTIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:238 MERTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1813
Mailing Address - Country:US
Mailing Address - Phone:920-728-3338
Mailing Address - Fax:
Practice Address - Street 1:7540 NORTH 19 AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:888-873-4221
Practice Address - Fax:888-543-2289
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2014-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant