Provider Demographics
NPI:1619468444
Name:PATTERSON, XAVIER (COTA)
Entity Type:Individual
Prefix:
First Name:XAVIER
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N RICHMOND ST UNIT 308
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4697
Mailing Address - Country:US
Mailing Address - Phone:920-574-1677
Mailing Address - Fax:
Practice Address - Street 1:S77W12929 MCSHANE DR
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150
Practice Address - Country:US
Practice Address - Phone:414-529-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5486-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant