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General NPI Number Information
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NPI Number | 1316573520
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Entity Type | Individual
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Provider Name | KIANA D SPANBAUER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 3321 LOGAN DR APT 7
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City | OSHKOSH
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State | WI
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Zip | 54901-1178
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Country | US
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Telephone | 920-410-5660
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 WEBSTER WAY
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City | WAUPACA
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State | WI
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Zip | 54981-2303
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Country | US
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Telephone | 910-410-5660
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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 | 5671-27
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License Number State | WI
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