Healthcare Provider Details

I. General information

NPI: 1023526910
Provider Name (Legal Business Name): PEGGY E CAUFIELD COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2018
Last Update Date: 01/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2753 N WEIL ST LOWR
MILWAUKEE WI
53212-2617
US

IV. Provider business mailing address

2753 N WEIL ST LOWR
MILWAUKEE WI
53212-2617
US

V. Phone/Fax

Practice location:
  • Phone: 414-526-0840
  • Fax:
Mailing address:
  • Phone: 414-526-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5469-27
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: