Provider Demographics
NPI:1417117821
Name:KABAT, PAULA (COTA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:KABAT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:PAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1325
Mailing Address - Country:US
Mailing Address - Phone:920-731-7310
Mailing Address - Fax:
Practice Address - Street 1:325 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1325
Practice Address - Country:US
Practice Address - Phone:920-731-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI194-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant