Provider Demographics
NPI:1871206375
Name:REED BLEW, LAURA JEANNE (COTA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEANNE
Last Name:REED BLEW
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JEANNE
Other - Last Name:REED BLEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:6303 WESTGATE RD
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3927
Mailing Address - Country:US
Mailing Address - Phone:608-219-5589
Mailing Address - Fax:
Practice Address - Street 1:6303 WESTGATE RD
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3927
Practice Address - Country:US
Practice Address - Phone:608-219-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1786-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1786-27OtherSTATE OF WISCONSIN
WI1050530OtherNBCOT