Provider Demographics
NPI:1023282233
Name:WIEGERT, JOANNE LEE (COTA)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:LEE
Last Name:WIEGERT
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:W1364 CTY RD YY
Mailing Address - Street 2:
Mailing Address - City:OGEMA
Mailing Address - State:WI
Mailing Address - Zip Code:54459-8446
Mailing Address - Country:US
Mailing Address - Phone:715-546-3303
Mailing Address - Fax:
Practice Address - Street 1:W1364 CTY RD YY
Practice Address - Street 2:
Practice Address - City:OGEMA
Practice Address - State:WI
Practice Address - Zip Code:54459-8446
Practice Address - Country:US
Practice Address - Phone:715-546-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI904027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40890700Medicaid