Provider Demographics
NPI:1912481995
Name:CROMWELL, TERESA LOUISE (COTA)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LOUISE
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:LOUISE
Other - Last Name:FREIBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4810 BARBICAN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-4186
Mailing Address - Country:US
Mailing Address - Phone:715-393-0400
Mailing Address - Fax:715-393-0435
Practice Address - Street 1:4810 BARBICAN AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-4186
Practice Address - Country:US
Practice Address - Phone:715-393-0400
Practice Address - Fax:715-393-0435
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5528224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant