MEDICARE: MS. KATHRYN M WIBERG 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	251C00000X	Developmentally Disabled Services Day Training Agency	5773-27	WI

General Provider Information

NPI Number	:	1700453834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN M WIBERG COTA

Provider Business Mailing Address
First Line	:	3015 S 45TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53219-3415
Country	:	US
Telephone Number	:	262-909-5321
Fax Number	:

Provider Business Practice Location Address
First Line	:	3015 S 45TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53219-3415
Country	:	US
Telephone Number	:	262-909-5321
Fax Number	:

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

Provider Enumeration Date	:	06/08/2021
Last Update Date	:	04/07/2026

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