Provider Demographics
NPI:1982471900
Name:WITTMERSHAUS, JULIA (COTA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:WITTMERSHAUS
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:N67W24833 STONEGATE CT UNIT 107
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-2581
Mailing Address - Country:US
Mailing Address - Phone:262-623-8246
Mailing Address - Fax:
Practice Address - Street 1:N67W24833 STONEGATE CT UNIT 107
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-2581
Practice Address - Country:US
Practice Address - Phone:262-623-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5809-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant