Provider Demographics
NPI:1295037018
Name:HODGSON, KATINA (COTA)
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:
Last Name:HODGSON
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 1:320 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CORNELL
Mailing Address - State:WI
Mailing Address - Zip Code:54732-8120
Mailing Address - Country:US
Mailing Address - Phone:715-239-0440
Mailing Address - Fax:
Practice Address - Street 1:320 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CORNELL
Practice Address - State:WI
Practice Address - Zip Code:54732-8120
Practice Address - Country:US
Practice Address - Phone:715-239-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4795-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant