Provider Demographics
NPI:1538609821
Name:BUERGER, MARISA (COTA)
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:
Last Name:BUERGER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:SAUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:706 BRATLEY DR
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-1143
Mailing Address - Country:US
Mailing Address - Phone:715-373-6425
Mailing Address - Fax:715-373-5655
Practice Address - Street 1:706 BRATLEY DR
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891-1143
Practice Address - Country:US
Practice Address - Phone:715-373-6425
Practice Address - Fax:715-373-5655
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1371-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant