Provider Demographics
NPI:1184927436
Name:BIEDERMAN, AMY NICOLE (COTA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NICOLE
Last Name:BIEDERMAN
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 1:5738 COUNTY ROAD Y
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:WI
Mailing Address - Zip Code:54412-9504
Mailing Address - Country:US
Mailing Address - Phone:715-567-0610
Mailing Address - Fax:
Practice Address - Street 1:5738 COUNTY ROAD Y
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:WI
Practice Address - Zip Code:54412-9504
Practice Address - Country:US
Practice Address - Phone:715-567-0610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4755027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant