MEDICARE: JENNIFER LYNN FRAFJORD 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	4828-27	WI

General Provider Information

NPI Number	:	1750661989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN FRAFJORD COTA

Provider Business Mailing Address
First Line	:	N5858 NELSON RD
Second Line	:
City	:	GLEN FLORA
State	:	WI
Zip	:	54526-9673
Country	:	US
Telephone Number	:	715-322-5664
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 PEARL ST
Second Line	:
City	:	RIB LAKE
State	:	WI
Zip	:	54470-9322
Country	:	US
Telephone Number	:	715-427-5297
Fax Number	:

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

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	08/19/2011

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