Provider Demographics
NPI:1841370624
Name:NEEDHAM, JODI LYNN (COTA)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:CORDTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:WONEWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53968
Mailing Address - Country:US
Mailing Address - Phone:608-464-7690
Mailing Address - Fax:
Practice Address - Street 1:400 WATER AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:WI
Practice Address - Zip Code:54634
Practice Address - Country:US
Practice Address - Phone:608-489-8260
Practice Address - Fax:608-489-8193
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1367027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI693182OtherDPI