Healthcare Provider Details

I. General information

NPI: 1033386404
Provider Name (Legal Business Name): VANESSA PLOEDERL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA FRANCL COTA

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 PILGRIM WAY
GREEN BAY WI
54304-5028
US

IV. Provider business mailing address

1040 PILGRIM WAY
GREEN BAY WI
54304-5028
US

V. Phone/Fax

Practice location:
  • Phone: 920-405-3522
  • Fax: 920-405-3523
Mailing address:
  • Phone: 920-405-3522
  • Fax: 920-405-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4591-027
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: