Provider Demographics
NPI:1770641896
Name:ZERNZACH, CAROLYN SUE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:SUE
Last Name:ZERNZACH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:SUE
Other - Last Name:NEWCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:725 BUTLER AVE PARKVIEW HEALTH CENTER ATTN CAROLYN
Mailing Address - City:WINNEBAGO
Mailing Address - State:WI
Mailing Address - Zip Code:54985-0010
Mailing Address - Country:US
Mailing Address - Phone:920-235-5100
Mailing Address - Fax:920-233-7352
Practice Address - Street 1:725 BUTLER AVE
Practice Address - Street 2:PARKVIEW HEALTH CENTER ATTN CAROLYN
Practice Address - City:WINNEBAGO
Practice Address - State:WI
Practice Address - Zip Code:54985-0010
Practice Address - Country:US
Practice Address - Phone:920-235-5100
Practice Address - Fax:920-233-7352
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1654027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40700400Medicare ID - Type Unspecified