Provider Demographics
NPI:1194264101
Name:WALOTKA, JANET K (COTA)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:K
Last Name:WALOTKA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:K
Other - Last Name:SHILOBRIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:110 BELMONT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-3129
Mailing Address - Country:US
Mailing Address - Phone:608-249-7391
Mailing Address - Fax:
Practice Address - Street 1:110 BELMONT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-3129
Practice Address - Country:US
Practice Address - Phone:608-249-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI773-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant