Provider Demographics
NPI:1447610845
Name:SCHULTZ, ELIZABETH (COTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 S 105TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-2544
Mailing Address - Country:US
Mailing Address - Phone:414-429-0709
Mailing Address - Fax:
Practice Address - Street 1:9455 W WATERTOWN PLANK RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3559
Practice Address - Country:US
Practice Address - Phone:414-429-0709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1572-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant