Healthcare Provider Details

I. General information

NPI: 1316853997
Provider Name (Legal Business Name): KRYSTAL WALKER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 3RD ST W
ASHLAND WI
54806-1311
US

IV. Provider business mailing address

13680N COUNTY ROAD D
HURLEY WI
54534-9105
US

V. Phone/Fax

Practice location:
  • Phone: 715-682-8172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: