Provider Demographics
NPI:1699442376
Name:SAULD, EDWARD RICHARD (COTA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:RICHARD
Last Name:SAULD
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 N WESTHAVEN DR APT 104
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-5427
Mailing Address - Country:US
Mailing Address - Phone:906-221-5303
Mailing Address - Fax:
Practice Address - Street 1:2725 S MOORLAND RD STE 301
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-3720
Practice Address - Country:US
Practice Address - Phone:414-329-2432
Practice Address - Fax:414-329-2509
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4889-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant