MEDICARE: MRS. ANGELA MARY KLASS COTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	4649-27	WI

General Provider Information

NPI Number	:	1033486444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MARY KLASS COTA

Provider Business Mailing Address
First Line	:	3020 S 97TH ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-3628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 S 97TH ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-3628
Country	:	US
Telephone Number	:	414-510-0647
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	08/15/2024

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