Healthcare Provider Details

I. General information

NPI: 1245353549
Provider Name (Legal Business Name): JAIME R RYCZEK COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E6545 FULLER RD
REEDSBURG WI
53959-9127
US

IV. Provider business mailing address

E6545 FULLER ROAD
REEDSBURG WI
53959
US

V. Phone/Fax

Practice location:
  • Phone: 608-524-4442
  • Fax:
Mailing address:
  • Phone: 608-524-4442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1628-027
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: