Provider Demographics
NPI:1750557153
Name:KAUFFELD, LINDA JEAN (COTA)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JEAN
Last Name:KAUFFELD
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:W9168 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-4143
Mailing Address - Country:US
Mailing Address - Phone:920-261-3267
Mailing Address - Fax:
Practice Address - Street 1:W9168 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-4143
Practice Address - Country:US
Practice Address - Phone:920-261-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40683700Medicaid