Provider Demographics
NPI:1841875432
Name:FITZPATRICK, SHEENAH MARIE (COTA)
Entity type:Individual
Prefix:MRS
First Name:SHEENAH
Middle Name:MARIE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:SHEENAH
Other - Middle Name:MARIE
Other - Last Name:OTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 GRANDVIEW AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-1386
Mailing Address - Country:US
Mailing Address - Phone:608-377-0617
Mailing Address - Fax:
Practice Address - Street 1:1051 CLARK ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-2321
Practice Address - Country:US
Practice Address - Phone:608-524-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5729-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant