Healthcare Provider Details

I. General information

NPI: 1114148756
Provider Name (Legal Business Name): TERI ANN HENDERSON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 LAWRENCE AVE
PARK FALLS WI
54552-1431
US

IV. Provider business mailing address

N7953 WILSON LAKE RD
PHILLIPS WI
54555-6740
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-2449
  • Fax:
Mailing address:
  • Phone: 715-339-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1646-027
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: