Healthcare Provider Details

I. General information

NPI: 1215032834
Provider Name (Legal Business Name): TERRY STRODTHOFF COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 ENLOE ST
HUDSON WI
54016-8173
US

IV. Provider business mailing address

2314 VESTERHEIM ST
EAU CLAIRE WI
54703-3758
US

V. Phone/Fax

Practice location:
  • Phone: 715-386-2128
  • Fax: 715-386-6119
Mailing address:
  • Phone: 715-839-7415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number513
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: