Provider Demographics
NPI:1588121206
Name:HANSON, KALA MARIE (COTA)
Entity type:Individual
Prefix:MRS
First Name:KALA
Middle Name:MARIE
Last Name:HANSON
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 1:7570 S BERGE RD
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:WI
Mailing Address - Zip Code:54836-9623
Mailing Address - Country:US
Mailing Address - Phone:715-338-4628
Mailing Address - Fax:
Practice Address - Street 1:8274 E SAN RD
Practice Address - Street 2:
Practice Address - City:SOUTH RANGE
Practice Address - State:WI
Practice Address - Zip Code:54874-8621
Practice Address - Country:US
Practice Address - Phone:715-398-3523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5065-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant