Healthcare Provider Details

I. General information

NPI: 1417431412
Provider Name (Legal Business Name): LAUREN SCHOETTLER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19395 W CAPITOL DR STE 200
BROOKFIELD WI
53045-2736
US

IV. Provider business mailing address

19395 W CAPITOL DR STE 200
BROOKFIELD WI
53045-2736
US

V. Phone/Fax

Practice location:
  • Phone: 262-923-7101
  • Fax: 262-923-7178
Mailing address:
  • Phone: 262-923-7101
  • Fax: 262-923-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5190
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: