Healthcare Provider Details

I. General information

NPI: 1831663574
Provider Name (Legal Business Name): CHELSEA EMILIE HEYRMAN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 2ND AVE
NEW GLARUS WI
53574-9776
US

IV. Provider business mailing address

5325 FROSTY LN
MADISON WI
53705-2734
US

V. Phone/Fax

Practice location:
  • Phone: 608-527-4390
  • Fax:
Mailing address:
  • Phone: 262-490-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number529627
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: