=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487922613
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE ROCHELLE WUENSCH COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2011
-----------------------------------------------------
Last Update Date | 12/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2448 S 102ND ST SUITE 250
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53227-2466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-877-7018
-----------------------------------------------------
Fax | 414-350-4260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 503 EAGLE AVE
-----------------------------------------------------
City | ROCKLAND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54653-9709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-486-4434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 1760-27
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------