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Contact Information

TINA M AMUNDSON, COTA
500 GRANT AVE
OMRO, WI54963-1342
 Phone: 920-685-2755
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Occupational Therapy Assistant

224Z00000X
Indicates primary specialty

NPI Profile & details for TINA M AMUNDSON · (Female)

NPI Number 1720230220
Status Active
Credentials COTA (Certified Occupational Therapy Assistant)
Entity Individual
Enumeration date 10/15/2008
Last updated 08/29/2012 - About 14 years ago
Sole proprietor 1 Yes
Identifiers
  • WI License # 747-27
  • WI Medicaid 40761400
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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