Provider Demographics
NPI:1124151451
Name:LAITAMAKI, NIKOLAI S (LAT)
Entity type:Individual
Prefix:
First Name:NIKOLAI
Middle Name:S
Last Name:LAITAMAKI
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 HERDA AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-9604
Mailing Address - Country:US
Mailing Address - Phone:262-515-2811
Mailing Address - Fax:
Practice Address - Street 1:635 HERDA AVE
Practice Address - Street 2:
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181-9604
Practice Address - Country:US
Practice Address - Phone:262-515-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI236-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer