Provider Demographics
NPI:1952027823
Name:DRAKE, VICKIE FAY (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:FAY
Last Name:DRAKE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MAPLE AIRE DR
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUNDS
Mailing Address - State:WI
Mailing Address - Zip Code:53517-9655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:429 S YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1021
Practice Address - Country:US
Practice Address - Phone:608-277-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7019-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant