Provider Demographics
NPI:1093229015
Name:HIGGINS, CORTNEY
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1548 STATE ROAD 106
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:WI
Mailing Address - Zip Code:53156-9678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:N1548 STATE ROAD 106
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:WI
Practice Address - Zip Code:53156-9678
Practice Address - Country:US
Practice Address - Phone:262-364-6967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1441212213Medicaid