Provider Demographics
NPI:1780840165
Name:SHELTON, AMY MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:SHELTON
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 1:2990 CAHILL MAIN
Mailing Address - Street 2:COMMUNICATION INNOVATIONS
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7130
Mailing Address - Country:US
Mailing Address - Phone:608-204-6083
Mailing Address - Fax:608-204-6183
Practice Address - Street 1:2990 CAHILL MAIN
Practice Address - Street 2:COMMUNICATION INNOVATIONS
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7130
Practice Address - Country:US
Practice Address - Phone:608-204-6083
Practice Address - Fax:608-204-6183
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI323224Z00000X
WI323-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant