Provider Demographics
NPI:1619411758
Name:PINNOW, JODI (COTA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:PINNOW
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 1:2512 NEW PINE DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-1378
Mailing Address - Country:US
Mailing Address - Phone:715-833-0400
Mailing Address - Fax:
Practice Address - Street 1:2512 NEW PINE DRIVE
Practice Address - Street 2:OAKWOOD VILLA
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720
Practice Address - Country:US
Practice Address - Phone:715-833-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5064-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant