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Contact Information

JUSTINE A BANTLE, COTA
701 WILLOW ST
PESHTIGO, WI54157
 Phone: 715-582-3962
 Fax: 715-582-9115
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Occupational Therapy Assistant

224Z00000X
Indicates primary specialty

NPI Profile & details for JUSTINE A BANTLE · (Female)

NPI Number 1427203827
Status Active
Credentials COTA (Certified Occupational Therapy Assistant)
Entity Individual
Enumeration date 11/26/2008
Last updated 11/26/2008 - About 18 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 1992-027
  • WI Medicaid 41073500
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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