Healthcare Provider Details

I. General information

NPI: 1487565727
Provider Name (Legal Business Name): LAURA MOREAU COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 PANKRATZ ST
MADISON WI
53704-4069
US

IV. Provider business mailing address

1802 PANKRATZ ST
MADISON WI
53704-4069
US

V. Phone/Fax

Practice location:
  • Phone: 608-661-8200
  • Fax:
Mailing address:
  • Phone: 608-661-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7050-27
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: