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General NPI Number Information
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NPI Number | 1255716718
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Entity Type | Individual
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Provider Name | AMBER LOUISE GEIGER COTA
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Gender | Female
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | N4131 DUCK CREEK CT
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City | FREEDOM
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State | WI
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Zip | 54130-7278
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Country | US
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Telephone | 920-585-3145
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Fax |
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Provider Business Mailing Address
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Address Line | 314 E 14TH STREET
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City | KAUKAUNA
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State | WI
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Zip | 54130-0000
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Country | US
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Telephone | 920-766-6020
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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 | 4919
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License Number State | WI
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