MEDICARE: TERI ANN HENDERSON 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	1646-027	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1646-027	OTHER	WI	OT ASSISTANT

General Provider Information

NPI Number	:	1114148756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI ANN HENDERSON COTA

Provider Business Mailing Address
First Line	:	N7953 WILSON LAKE RD
Second Line	:
City	:	PHILLIPS
State	:	WI
Zip	:	54555-6740
Country	:	US
Telephone Number	:	715-339-3221
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 LAWRENCE AVE
Second Line	:
City	:	PARK FALLS
State	:	WI
Zip	:	54552-1431
Country	:	US
Telephone Number	:	715-762-2449
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/09/2007

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