MEDICARE: MRS. SHEILA ELICE HOPP COTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	734-27	WI

General Provider Information

NPI Number	:	1053688408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHEILA ELICE HOPP COTA

Provider Business Mailing Address
First Line	:	44 CONCORD DR
Second Line	:
City	:	FOND DU LAC
State	:	WI
Zip	:	54935-2956
Country	:	US
Telephone Number	:	920-979-1002
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 CONCORD DR
Second Line	:
City	:	FOND DU LAC
State	:	WI
Zip	:	54935-2956
Country	:	US
Telephone Number	:	920-979-1002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	11/29/2011

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