Provider Demographics
NPI:1356772735
Name:KRASOTIN, NATASHA (COTA)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:KRASOTIN
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 1:3933 S PRAIRIE HILL LN
Mailing Address - Street 2:SUITE 316
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3933 S PRAIRIE HILL LN
Practice Address - Street 2:SUITE 316
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-2371
Practice Address - Country:US
Practice Address - Phone:888-891-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5030-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant