Healthcare Provider Details

I. General information

NPI: 1174757264
Provider Name (Legal Business Name): DEBRA M. SANCHEZ COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 9TH ST
DE PERE WI
54115-1393
US

IV. Provider business mailing address

990 N RIDGEVIEW CT
SOBIESKI WI
54171-9404
US

V. Phone/Fax

Practice location:
  • Phone: 920-338-4145
  • Fax: 920-338-9121
Mailing address:
  • Phone: 920-822-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1735027
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: