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NPI Code Detail

MEDICARE: JORDAN MICHAEL CLOW COTA

MEDICARE: JORDAN MICHAEL CLOW 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 Assistant5415WI

General Provider Information

NPI Number : 1598237596
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN MICHAEL CLOW COTA
Provider Business Mailing Address
First Line : 725 BUTLER AVE
Second Line :
City : OSHKOSH
State : WI
Zip : 54901-8149
Country : US
Telephone Number : 920-237-6300
Fax Number :
Provider Business Practice Location Address
First Line : 725 BUTLER AVE
Second Line :
City : OSHKOSH
State : WI
Zip : 54901-8149
Country : US
Telephone Number : 920-237-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2019
Last Update Date : 01/02/2019

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Directions to “ JORDAN MICHAEL CLOW COTA” Practice Location

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