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General NPI Number Information
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NPI Number | 1235653163
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Entity Type | Individual
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Provider Name | AMANDA M WALESH COTA, CLT
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Gender | Female
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 08/02/2017
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Provider Practice Location Address
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Address Line | 2629 N 7TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53083-4932
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Country | US
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Telephone | 920-551-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 ILLINOIS AVE
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City | NEW HOLSTEIN
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State | WI
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Zip | 53061-1210
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Country | US
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Telephone | 920-579-0879
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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 | 5310
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5310-27
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License Number State | WI
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