Healthcare Provider Details

I. General information

NPI: 1760217996
Provider Name (Legal Business Name): SARAH HURD COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S JEFFERSON ST
VERONA WI
53593-1493
US

IV. Provider business mailing address

671 SPRING ST UNIT 2104
SUN PRAIRIE WI
53590-9327
US

V. Phone/Fax

Practice location:
  • Phone: 608-845-6465
  • Fax:
Mailing address:
  • Phone: 608-515-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7176-27
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: