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NPI Code Detail

MEDICARE: JAMIE HOLEMAN COTA

MEDICARE: JAMIE HOLEMAN 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 Assistant5338WI

General Provider Information

NPI Number : 1336673433
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE HOLEMAN COTA
Provider Business Mailing Address
First Line : 1555 COMMONWEALTH DR APT 7
Second Line :
City : FORT ATKINSON
State : WI
Zip : 53538-3134
Country : US
Telephone Number : 920-723-9263
Fax Number :
Provider Business Practice Location Address
First Line : 9350 W FOND DU LAC AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53225-1714
Country : US
Telephone Number : 414-438-4360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2017
Last Update Date : 04/14/2017

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