Provider Demographics
NPI:1073409181
Name:BESTUL, JOLIE BETH X
Entity type:Individual
Prefix:
First Name:JOLIE
Middle Name:BETH
Last Name:BESTUL
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E1356 MADSON RD
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945-9231
Mailing Address - Country:US
Mailing Address - Phone:715-445-4440
Mailing Address - Fax:
Practice Address - Street 1:505 W IOLA ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945-9136
Practice Address - Country:US
Practice Address - Phone:715-445-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1153-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant