Provider Demographics
NPI:1437322757
Name:GUSKI, LORRIE J (COTA)
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:J
Last Name:GUSKI
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 1:2405 CAMPBELL DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3636
Mailing Address - Country:US
Mailing Address - Phone:715-682-8172
Mailing Address - Fax:715-682-6662
Practice Address - Street 1:2405 CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3636
Practice Address - Country:US
Practice Address - Phone:715-682-8172
Practice Address - Fax:715-682-6662
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1867-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40878800Medicaid