Provider Demographics
NPI:1194971424
Name:BARRETT, SU-ANNE (COTA/L)
Entity type:Individual
Prefix:
First Name:SU-ANNE
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4739 WILDERNESS LN
Mailing Address - Street 2:
Mailing Address - City:HARSHAW
Mailing Address - State:WI
Mailing Address - Zip Code:54529-9631
Mailing Address - Country:US
Mailing Address - Phone:309-212-3723
Mailing Address - Fax:
Practice Address - Street 1:209 WILDERNESS VIEW DR
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-8357
Practice Address - Country:US
Practice Address - Phone:877-823-8357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057002858224Z00000X, 174400000X
WI5346-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant