Provider Demographics
NPI:1912284456
Name:WOBIG, JEAN MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:WOBIG
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 1:3730 TROY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-8162
Mailing Address - Country:US
Mailing Address - Phone:920-744-7153
Mailing Address - Fax:
Practice Address - Street 1:1010 E WAUSAU AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-3101
Practice Address - Country:US
Practice Address - Phone:715-842-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1459-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant