Provider Demographics
NPI:1578894127
Name:HANSON, WENDY LYNN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LYNN
Last Name:HANSON
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 1:933 NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54907
Mailing Address - Country:US
Mailing Address - Phone:920-748-9138
Mailing Address - Fax:920-748-0527
Practice Address - Street 1:933 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54907
Practice Address - Country:US
Practice Address - Phone:920-748-9138
Practice Address - Fax:920-748-0527
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI700-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40733800Medicaid