MEDICARE: AMY ANNA JACOB 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	899027	WI

General Provider Information

NPI Number	:	1730347006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ANNA JACOB COTA

Provider Business Mailing Address
First Line	:	27672 ONION HOLLOW LN
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556-9002
Country	:	US
Telephone Number	:	608-475-9151
Fax Number	:

Provider Business Practice Location Address
First Line	:	27672 ONION HOLLOW LANE
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556-9002
Country	:	US
Telephone Number	:	608-475-9151
Fax Number	:

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

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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