Provider Demographics
NPI:1235419730
Name:WELIN, JOSEPH LEO (COTA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEO
Last Name:WELIN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 21ST ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5813
Mailing Address - Country:US
Mailing Address - Phone:651-485-5497
Mailing Address - Fax:
Practice Address - Street 1:2600 WARD AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7424
Practice Address - Country:US
Practice Address - Phone:608-787-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4801-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant