Provider Demographics
NPI:1366739393
Name:SCHICKOWSKI, TANYA (OTA)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:SCHICKOWSKI
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 TRI PARK WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1652
Mailing Address - Country:US
Mailing Address - Phone:920-830-6697
Mailing Address - Fax:920-830-6707
Practice Address - Street 1:444 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:KOHLER
Practice Address - State:WI
Practice Address - Zip Code:53044-1515
Practice Address - Country:US
Practice Address - Phone:920-457-4441
Practice Address - Fax:920-459-1666
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4820-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant