Provider Demographics
NPI:1336299965
Name:NESS, JACQUELINE SUSAN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:SUSAN
Last Name:NESS
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 1:702 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2243
Mailing Address - Country:US
Mailing Address - Phone:608-850-9072
Mailing Address - Fax:
Practice Address - Street 1:245 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-1013
Practice Address - Country:US
Practice Address - Phone:608-643-3383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1980-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant