Provider Demographics
NPI:1194697714
Name:MARCOUILLER, TEAGAN (COTA)
Entity type:Individual
Prefix:
First Name:TEAGAN
Middle Name:
Last Name:MARCOUILLER
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 1:203 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-1631
Mailing Address - Country:US
Mailing Address - Phone:608-440-0302
Mailing Address - Fax:
Practice Address - Street 1:323 W MONROE ST
Practice Address - Street 2:
Practice Address - City:WYOCENA
Practice Address - State:WI
Practice Address - Zip Code:53969-7168
Practice Address - Country:US
Practice Address - Phone:608-429-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI539194224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty