Provider Demographics
NPI:1346012184
Name:PITZER, TINA ANN MARIE (COTA,AND CNA)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:ANN MARIE
Last Name:PITZER
Suffix:
Gender:F
Credentials:COTA,AND CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59006 DUCHARME RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:WI
Mailing Address - Zip Code:54626-8170
Mailing Address - Country:US
Mailing Address - Phone:715-579-6260
Mailing Address - Fax:
Practice Address - Street 1:700 S FREMONT ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-2331
Practice Address - Country:US
Practice Address - Phone:608-326-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7105-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant