MEDICARE: CIERRA DAWN WHEELWRIGHT COTA/L

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	11376991-4202	UT

General Provider Information

NPI Number	:	1154193514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIERRA DAWN WHEELWRIGHT COTA/L

Provider Business Mailing Address
First Line	:	1572 PROGRESS ST
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-7304
Country	:	US
Telephone Number	:	801-783-8374
Fax Number	:

Provider Business Practice Location Address
First Line	:	1572 PROGRESS ST
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-7304
Country	:	US
Telephone Number	:	801-783-8374
Fax Number	:

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

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	10/27/2023

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