Provider Demographics
NPI:1770821076
Name:STAGLIANO, ABBIE ARLENE (COTA)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:ARLENE
Last Name:STAGLIANO
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 1:1415 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1133
Mailing Address - Country:US
Mailing Address - Phone:608-293-5328
Mailing Address - Fax:
Practice Address - Street 1:3151 COUNTY ROAD CH
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-9108
Practice Address - Country:US
Practice Address - Phone:608-935-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4958-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant