Healthcare Provider Details

I. General information

NPI: 1588938146
Provider Name (Legal Business Name): CHERYL ANN BARFKNECHT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N3015 HICKORY RD
BYRON WI
53006-1126
US

IV. Provider business mailing address

N3015 HICKORY RD
BYRON WI
53006-1126
US

V. Phone/Fax

Practice location:
  • Phone: 920-933-4344
  • Fax:
Mailing address:
  • Phone: 920-933-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number486527
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: