Healthcare Provider Details

I. General information

NPI: 1194697714
Provider Name (Legal Business Name): TEAGAN MARCOUILLER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W MONROE ST
WYOCENA WI
53969-7168
US

IV. Provider business mailing address

203 6TH ST
WAUNAKEE WI
53597-1631
US

V. Phone/Fax

Practice location:
  • Phone: 608-429-2181
  • Fax:
Mailing address:
  • Phone: 608-440-0302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number539194
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: