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NPI Code Detail

MEDICARE: AMY JO FOLKESTAD COTA/L

MEDICARE: AMY JO FOLKESTAD COTA/L
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
1224Z00000XOccupational Therapy Assistant1893-27WI
2224Z00000XOccupational Therapy Assistant200330MN

General Provider Information

NPI Number : 1477897825
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY JO FOLKESTAD COTA/L
Provider Business Mailing Address
First Line : 35 N 28TH ST
Second Line :
City : SUPERIOR
State : WI
Zip : 54880-5557
Country : US
Telephone Number : 715-392-3300
Fax Number :
Provider Business Practice Location Address
First Line : 35 N 28TH ST
Second Line :
City : SUPERIOR
State : WI
Zip : 54880-5557
Country : US
Telephone Number : 715-392-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2012
Last Update Date : 11/23/2012

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