Provider Demographics
NPI:1942322474
Name:MACHHOLZWESELY, KAREN S (COTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:MACHHOLZWESELY
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 1:2524 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-8115
Mailing Address - Country:US
Mailing Address - Phone:641-469-4353
Mailing Address - Fax:
Practice Address - Street 1:400 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3713
Practice Address - Country:US
Practice Address - Phone:641-469-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00627224Z00000X
MO004885224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant