Provider Demographics
NPI:1649066606
Name:ARVOLD, ADELHEID CHRISTA (COTA)
Entity type:Individual
Prefix:
First Name:ADELHEID
Middle Name:CHRISTA
Last Name:ARVOLD
Suffix:
Gender:
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 MARY ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-1511
Mailing Address - Country:US
Mailing Address - Phone:920-382-0639
Mailing Address - Fax:
Practice Address - Street 1:198 COUNTY ROAD DF
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-9515
Practice Address - Country:US
Practice Address - Phone:920-386-3548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5744-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant