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General NPI Number Information
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NPI Number | 1033486444
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Entity Type | Individual
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Provider Name | ANGELA MARY KLASS COTA
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Gender | Female
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 3020 S 97TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-3628
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Country | US
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Telephone | 414-510-0647
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Fax |
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Provider Business Mailing Address
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Address Line | 3020 S 97TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-3628
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 4649-27
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License Number State | WI
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