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General NPI Number Information
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NPI Number | 1699442376
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Entity Type | Individual
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Provider Name | EDWARD RICHARD SAULD COTA
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Gender | Male
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 2725 S MOORLAND RD STE 301
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City | NEW BERLIN
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State | WI
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Zip | 53151-3720
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Country | US
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Telephone | 414-329-2432
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Fax | 414-329-2509
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Provider Business Mailing Address
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Address Line | 367 N WESTHAVEN DR APT 104
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City | OSHKOSH
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State | WI
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Zip | 54904-5427
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Country | US
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Telephone | 906-221-5303
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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 | 4889-27
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License Number State | WI
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