Provider Demographics
NPI:1598939050
Name:RONCHI, MARJORIE L (COTA)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:L
Last Name:RONCHI
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 1:1635 MAPLE LANE
Mailing Address - Street 2:BEHAVIORAL HEALTH SERVICES
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806
Mailing Address - Country:US
Mailing Address - Phone:715-685-5400
Mailing Address - Fax:715-685-5102
Practice Address - Street 1:1635 MAPLE LANE
Practice Address - Street 2:BEHAVIORAL HEALTH SERVICES
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806
Practice Address - Country:US
Practice Address - Phone:715-685-5400
Practice Address - Fax:715-685-5102
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI913-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40889500Medicaid