Provider Demographics
NPI:1558815951
Name:DUDZINSKE, LISA E (COTA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:E
Last Name:DUDZINSKE
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 1:2801 W KINNICKINNIC RIVER PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3699
Mailing Address - Country:US
Mailing Address - Phone:414-649-7946
Mailing Address - Fax:414-385-8799
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 160
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3699
Practice Address - Country:US
Practice Address - Phone:414-649-7946
Practice Address - Fax:414-385-8799
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI577-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant