Provider Demographics
NPI:1639512163
Name:CZARNECKI, LORI L (COTA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:CZARNECKI
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 1:7300 W. DEAN RD.
Mailing Address - Street 2:TRINITY VILLAGE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223
Mailing Address - Country:US
Mailing Address - Phone:414-371-7394
Mailing Address - Fax:414-357-7834
Practice Address - Street 1:7300 W. DEAN RD.
Practice Address - Street 2:TRINITY VILLAGE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223
Practice Address - Country:US
Practice Address - Phone:414-371-7394
Practice Address - Fax:414-357-7834
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI301118224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant