Healthcare Provider Details

I. General information

NPI: 1922255629
Provider Name (Legal Business Name): TAMMI ANN SCHELLIN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 E ALFRED ST
WEYAUWEGA WI
54983-9024
US

IV. Provider business mailing address

717 E ALFRED
WEYAUWEGA WI
54983
US

V. Phone/Fax

Practice location:
  • Phone: 920-867-3121
  • Fax: 920-867-3997
Mailing address:
  • Phone: 920-867-3121
  • Fax: 920-867-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number927-027
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: