Provider Demographics
NPI:1124318480
Name:LILLIE, MARGARET BETH (COTA)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:BETH
Last Name:LILLIE
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 1:5701 W GREEN BROOK DR
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2332
Mailing Address - Country:US
Mailing Address - Phone:414-355-3484
Mailing Address - Fax:
Practice Address - Street 1:5701 W GREEN BROOK DR
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2332
Practice Address - Country:US
Practice Address - Phone:414-355-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant