Provider Demographics
NPI:1851450399
Name:KNAPTON, HEIDI SUE (COTA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:SUE
Last Name:KNAPTON
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 1:205 SCENIC CIR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:WI
Mailing Address - Zip Code:53559-9323
Mailing Address - Country:US
Mailing Address - Phone:608-655-4658
Mailing Address - Fax:
Practice Address - Street 1:407 N 8TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1872
Practice Address - Country:US
Practice Address - Phone:608-437-5511
Practice Address - Fax:608-437-9603
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI346-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40903300Medicaid