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NPI Code Detail

MEDICARE: MISS HOLLY MARIE PETE C.O.T.A.

MEDICARE: MISS HOLLY MARIE PETE C.O.T.A.
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 Assistant4638-027WI

General Provider Information

NPI Number : 1679727838
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS HOLLY MARIE PETE C.O.T.A.
Provider Business Mailing Address
First Line : 3805 PORTAGE RD APT 1
Second Line :
City : MADISON
State : WI
Zip : 53704-2765
Country : US
Telephone Number : 608-931-4278
Fax Number :
Provider Business Practice Location Address
First Line : 1616 W BENDER RD
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3802
Country : US
Telephone Number : 414-228-8700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2008
Last Update Date : 11/13/2008

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