=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841909306
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROOKE LYNN SCHUMACHER COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2022
-----------------------------------------------------
Last Update Date | 11/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4545 N 92ND ST
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53225-4899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-464-3880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N58W23747 HASTINGS CT UNIT 28
-----------------------------------------------------
City | SUSSEX
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53089-3785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-224-8911
-----------------------------------------------------
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 | 7041-27
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------