Provider Demographics
NPI:1710393509
Name:BUDESA, DANIJELA (COTA)
Entity Type:Individual
Prefix:
First Name:DANIJELA
Middle Name:
Last Name:BUDESA
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 1:4175 S 51ST ST
Mailing Address - Street 2:APT#3
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3229
Mailing Address - Country:US
Mailing Address - Phone:414-737-1827
Mailing Address - Fax:
Practice Address - Street 1:4175 S 51ST ST
Practice Address - Street 2:APT#3
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-3229
Practice Address - Country:US
Practice Address - Phone:414-737-1827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4994-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant