MEDICARE: JENNIFER G ALLCOX 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	5583-27	WI

General Provider Information

NPI Number	:	1861955189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER G ALLCOX COTA

Provider Business Mailing Address
First Line	:	N32W6883 PALMETTO CT
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012-2208
Country	:	US
Telephone Number	:	262-327-8224
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 N GREEN BAY RD
Second Line	:
City	:	RIVER HILLS
State	:	WI
Zip	:	53217-2047
Country	:	US
Telephone Number	:	414-858-6256
Fax Number	:

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

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	04/12/2019

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