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General NPI Number Information
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NPI Number | 1376614909
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Entity Type | Individual
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Provider Name | CATHERINE MARIE KOTH PTA
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 202 W MOHAWK DR
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City | TOMAHAWK
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State | WI
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Zip | 54487-2215
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Country | US
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Telephone | 715-453-7600
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Fax | 715-453-6403
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Provider Business Mailing Address
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Address Line | 1255 E KING RD
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City | TOMAHAWK
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State | WI
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Zip | 54487-2004
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Country | US
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Telephone | 715-453-4646
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 381-019
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License Number State | WI
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