NPI 1003569815

Tyler Christian Mogensen, COTA

Practitioner Occupational Therapy Assistant Appleton, WI

Practice location

Address: 325 E Florida Ave, Appleton, WI 54911-1325
Phone: (920) 731-7310

Registered specialties

Occupational Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224Z00000X Licence 5652 (WI)

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Registry record

NPI: 1003569815
Entity type: Individual
Sex (as registered): Male
NPI issued: 1 Feb 2022
Record last updated: 1 Feb 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.