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NPI Code Detail

MEDICARE: KENYA EVERETT COTA

MEDICARE: KENYA EVERETT 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 Assistant4847-27WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780934992
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENYA EVERETT COTA
Provider Business Mailing Address
First Line : 1414 N PROSPECT AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-3018
Country : US
Telephone Number : 414-277-8854
Fax Number : 414-276-2332
Provider Business Practice Location Address
First Line : 1414 N PROSPECT AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-3018
Country : US
Telephone Number : 414-277-8854
Fax Number : 414-276-2332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2012
Last Update Date : 12/29/2014

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Directions to “ KENYA EVERETT COTA” Practice Location

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