Provider Demographics
NPI:1629242227
Name:HELENIUS, JENNIFER BAST (COTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BAST
Last Name:HELENIUS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:BAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:422 3RD ST W
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1573
Mailing Address - Country:US
Mailing Address - Phone:715-682-0633
Mailing Address - Fax:715-682-0736
Practice Address - Street 1:422 3RD ST W
Practice Address - Street 2:SUITE 135
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1573
Practice Address - Country:US
Practice Address - Phone:715-682-0633
Practice Address - Fax:715-682-0736
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1066-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40889700Medicaid