Provider Demographics
NPI:1942794144
Name:BRESNAHAN, MARGARET PATRICE I (COTA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:PATRICE
Last Name:BRESNAHAN
Suffix:I
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:N3580 OAKWOOD PASS
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-8860
Mailing Address - Country:US
Mailing Address - Phone:920-418-8963
Mailing Address - Fax:
Practice Address - Street 1:604 S WEBB ST
Practice Address - Street 2:
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499-9040
Practice Address - Country:US
Practice Address - Phone:715-253-2125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5483-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant