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General NPI Number Information
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NPI Number | 1386167823
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Entity Type | Individual
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Provider Name | ALLISON RENEE SANFORD COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 303 W COURT ST STE 101
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City | JANESVILLE
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State | WI
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Zip | 53548-3865
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Country | US
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Telephone | 608-563-0113
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Fax | 608-563-0220
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Provider Business Mailing Address
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Address Line | 303 W COURT ST STE 101
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City | JANESVILLE
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State | WI
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Zip | 53548-3865
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Country | US
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Telephone |
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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 | 5857-27
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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 | 057.005764
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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