Provider Demographics
NPI:1053588186
Name:HELLICKSON, ANN LYNETTE (COTA)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:LYNETTE
Last Name:HELLICKSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:LYNETTE
Other - Last Name:HELLICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:508 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-4843
Mailing Address - Country:US
Mailing Address - Phone:608-831-8300
Mailing Address - Fax:
Practice Address - Street 1:6201 ELMWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3319
Practice Address - Country:US
Practice Address - Phone:608-830-5141
Practice Address - Fax:866-290-9061
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
WI98224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility