Eileen M Fossum
Occupational Therapy Assistant
614 S Rock Ave
Viroqua
, Wisconsin 54665-1936
Eileen M Fossum
Occupational Therapy Assistant
614 S Rock Ave
Viroqua
, Wisconsin 54665-1936
(608) 397-8368
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About
Features
Specialties
- Occupational Therapy Assistant
Languages spoken
- English
Location
First Address
- Eileen M Fossum
- N1530 Breidel Coulee Rd
- La Crosse, WI
- Zip : 54601-2168
- Phone : (608) 397-8368
Second Address
- Eileen M Fossum
- 614 S Rock Ave
- Viroqua, WI
- Zip : 54665-1936
- Phone : (608) 637-2171
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 224Z00000X | Occupational Therapy Assistant | 4813-27 | WI |
National Provider Identifier
| NPI | 1023500741 |
|---|---|
| Provider Name | Eileen M Fossum |
| First Address | La Crosse, WI 54601-2168 |
| Second Address | Viroqua, WI 54665-1936 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/05/2018 |
| Last Update Date | 16/06/2018 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.