Provider Demographics
NPI:1144500323
Name:STEINE, SALLY J (COTA)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:J
Last Name:STEINE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:KULIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3360 GATEWAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5115
Mailing Address - Country:US
Mailing Address - Phone:262-923-7101
Mailing Address - Fax:
Practice Address - Street 1:206 N WILLSON DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-1274
Practice Address - Country:US
Practice Address - Phone:715-598-7817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4818027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant