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General NPI Number Information
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NPI Number | 1124807755
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Entity Type | Individual
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Provider Name | AMBER L WOOD COTA
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Gender | Female
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 1280 CHANDLER DR
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City | SPOONER
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State | WI
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Zip | 54801-2202
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Country | US
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Telephone | 715-939-1745
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Fax |
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Provider Business Mailing Address
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Address Line | 16507 W STATE ROAD 77
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City | HAYWARD
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State | WI
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Zip | 54843-6423
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Country | US
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Telephone | 715-558-6074
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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 | 7100-27
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License Number State | WI
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