Provider Demographics
NPI:1245564996
Name:STOUFFER, JESSI RAI (COTA)
Entity Type:Individual
Prefix:MS
First Name:JESSI
Middle Name:RAI
Last Name:STOUFFER
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 1:802 E COUNTY HIGHWAY B
Mailing Address - Street 2:
Mailing Address - City:SHELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54871-4425
Mailing Address - Country:US
Mailing Address - Phone:715-468-7292
Mailing Address - Fax:715-468-4232
Practice Address - Street 1:802 E COUNTY HIGHWAY B
Practice Address - Street 2:
Practice Address - City:SHELL LAKE
Practice Address - State:WI
Practice Address - Zip Code:54871-4425
Practice Address - Country:US
Practice Address - Phone:715-468-7292
Practice Address - Fax:715-468-4232
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI459427224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant