Provider Demographics
NPI:1710583778
Name:TILL, ALANA (COTA)
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:
Last Name:TILL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 POWELL ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-1360
Mailing Address - Country:US
Mailing Address - Phone:715-559-2326
Mailing Address - Fax:
Practice Address - Street 1:725 KNAPP ST
Practice Address - Street 2:
Practice Address - City:CHETEK
Practice Address - State:WI
Practice Address - Zip Code:54728-9106
Practice Address - Country:US
Practice Address - Phone:715-924-4891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant