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General NPI Number Information
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NPI Number | 1184754681
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Entity Type | Individual
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Provider Name | SANDRA L. HALRON COTA
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 855 N WESTHAVEN DR
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City | OSHKOSH
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State | WI
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Zip | 54904-7668
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Country | US
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Telephone | 920-456-7155
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Fax |
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Provider Business Mailing Address
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Address Line | 119 MAIN ST
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City | WRIGHTSTOWN
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State | WI
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Zip | 54180-1051
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Country | US
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Telephone | 920-532-0273
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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 | 1347-027
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License Number State | WI
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