Provider Demographics
NPI:1447515655
Name:VON RUDEN, DANA MAE (COTA)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MAE
Last Name:VON RUDEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MAE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2758
Mailing Address - Country:US
Mailing Address - Phone:608-487-6222
Mailing Address - Fax:
Practice Address - Street 1:2600 WARD AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7424
Practice Address - Country:US
Practice Address - Phone:608-787-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant