Provider Demographics
NPI:1013689827
Name:TOWNSEND, BREEANNA LEE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:BREEANNA
Middle Name:LEE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:BREEANNA
Other - Middle Name:LEE
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:105 DONALD ST
Mailing Address - Street 2:
Mailing Address - City:CAMP DOUGLAS
Mailing Address - State:WI
Mailing Address - Zip Code:54618
Mailing Address - Country:US
Mailing Address - Phone:608-343-6599
Mailing Address - Fax:
Practice Address - Street 1:1505 BUTTS AVE
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660
Practice Address - Country:US
Practice Address - Phone:608-786-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI580627224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant