Provider Demographics
NPI:1548570518
Name:PATTERSON, MALIA LYNN (OT)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:LYNN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2611
Mailing Address - Country:US
Mailing Address - Phone:608-217-3227
Mailing Address - Fax:
Practice Address - Street 1:2600 RIB MOUNTAIN DR
Practice Address - Street 2:SUITE 220
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7196
Practice Address - Country:US
Practice Address - Phone:715-843-5300
Practice Address - Fax:715-843-5329
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4941-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist