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NPI Code Detail

MEDICARE: MRS. PAMELA L FRASER COTA

MEDICARE: MRS. PAMELA L FRASER 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
1224Z00000XOccupational Therapy Assistant1013027WI

General Provider Information

NPI Number : 1104093210
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PAMELA L FRASER COTA
Provider Business Mailing Address
First Line : 4115 S QUINCY AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-4471
Country : US
Telephone Number : 414-481-0284
Fax Number :
Provider Business Practice Location Address
First Line : 5404 W LOOMIS RD
Second Line :
City : GREENDALE
State : WI
Zip : 53129-1411
Country : US
Telephone Number : 414-421-0088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2008
Last Update Date : 05/08/2008

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Directions to “ MRS. PAMELA L FRASER COTA” Practice Location

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