Provider Demographics
NPI:1407063712
Name:BUSCH, PATRICIA HARRIET (COTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:HARRIET
Last Name:BUSCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TRICIA/PATRICIA
Other - Middle Name:
Other - Last Name:CROSS/LAFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1444 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-3720
Mailing Address - Country:US
Mailing Address - Phone:715-853-2413
Mailing Address - Fax:
Practice Address - Street 1:430 MANOR DR
Practice Address - Street 2:
Practice Address - City:SURING
Practice Address - State:WI
Practice Address - Zip Code:54174-9182
Practice Address - Country:US
Practice Address - Phone:920-842-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI976-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant