Provider Demographics
NPI:1962665323
Name:STELSON, DENISE RENEE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:RENEE
Last Name:STELSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:RENEE
Other - Last Name:BARTELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1436 SOUTH LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166
Mailing Address - Country:US
Mailing Address - Phone:715-526-6111
Mailing Address - Fax:715-524-5708
Practice Address - Street 1:3360 GATEWAY RD STE 100
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5115
Practice Address - Country:US
Practice Address - Phone:262-923-7171
Practice Address - Fax:262-923-7178
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI839027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40797400Medicaid