Healthcare Provider Details

I. General information

NPI: 1669798922
Provider Name (Legal Business Name): KRISTA LYN WIENER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
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

250 LAWRENCE AVE
PARK FALLS WI
54552-1431
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-2449
  • Fax: 715-762-3321
Mailing address:
  • Phone: 715-762-2449
  • Fax: 715-762-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4600-27
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: