Provider Demographics
NPI:1396182366
Name:NEMETH, NANCY JEAN (COTA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:NEMETH
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 1:2303 EMSLIE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2046
Mailing Address - Country:US
Mailing Address - Phone:262-542-9499
Mailing Address - Fax:
Practice Address - Street 1:3023 S. 84TH STREET
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2046
Practice Address - Country:US
Practice Address - Phone:414-607-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI440-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant