Provider Demographics
NPI:1518633908
Name:MECKELBERG, CIERRA ROSE (COTA)
Entity type:Individual
Prefix:MISS
First Name:CIERRA
Middle Name:ROSE
Last Name:MECKELBERG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:CIERRA
Other - Middle Name:ROSE
Other - Last Name:MECKELBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:N1713 HOT SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8573
Mailing Address - Country:US
Mailing Address - Phone:920-379-8164
Mailing Address - Fax:
Practice Address - Street 1:335 N WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-5909
Practice Address - Country:US
Practice Address - Phone:920-456-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist