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General NPI Number Information
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NPI Number | 1841370624
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Entity Type | Individual
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Provider Name | JODI LYNN NEEDHAM COTA
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 WATER AVE
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City | HILLSBORO
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State | WI
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Zip | 54634
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Country | US
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Telephone | 608-489-8260
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Fax | 608-489-8193
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Provider Business Mailing Address
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Address Line | PO BOX 371
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City | WONEWOC
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State | WI
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Zip | 53968
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Country | US
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Telephone | 608-464-7690
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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 | 1367027
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License Number State | WI
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