Provider Demographics
NPI:1750589685
Name:COLLINS, ARDYSS CAROL (COTA)
Entity type:Individual
Prefix:MRS
First Name:ARDYSS
Middle Name:CAROL
Last Name:COLLINS
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 1:27371 E DEVILS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54893-8703
Mailing Address - Country:US
Mailing Address - Phone:715-866-7999
Mailing Address - Fax:
Practice Address - Street 1:23926 4TH AVE
Practice Address - Street 2:
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-8312
Practice Address - Country:US
Practice Address - Phone:715-349-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1774-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant