Provider Demographics
NPI:1255716718
Name:GEIGER, AMBER LOUISE (COTA)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:LOUISE
Last Name:GEIGER
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 1:314 E 14TH STREET
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-0000
Mailing Address - Country:US
Mailing Address - Phone:920-766-6020
Mailing Address - Fax:
Practice Address - Street 1:N4131 DUCK CREEK CT
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:WI
Practice Address - Zip Code:54130-7278
Practice Address - Country:US
Practice Address - Phone:920-585-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4919224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20164800Medicaid
WI52-5617Medicare PIN