Healthcare Provider Details

I. General information

NPI: 1225670920
Provider Name (Legal Business Name): JUDY MARIE KEDLEY BOGE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDY K BOGE COTA

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 WINDSOR AVE
DUBUQUE IA
52001-1312
US

IV. Provider business mailing address

3485 WINDSOR AVE
DUBUQUE IA
52001-1312
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-7180
  • Fax: 847-730-2159
Mailing address:
  • Phone: 563-690-9637
  • Fax: 847-730-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number00025
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: