Healthcare Provider Details

I. General information

NPI: 1053681692
Provider Name (Legal Business Name): REBEKAH SOKEL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 SAINT ANTHONY DR
GREEN BAY WI
54311-5860
US

IV. Provider business mailing address

2961 SAINT ANTHONY DR
GREEN BAY WI
54311-5860
US

V. Phone/Fax

Practice location:
  • Phone: 920-468-0861
  • Fax: 920-468-5689
Mailing address:
  • Phone: 920-468-0861
  • Fax: 920-468-5689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4631-27
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: