MEDICARE: VALERIE ALT 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		WI

General Provider Information

NPI Number	:	1922416460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE ALT COTA

Provider Business Mailing Address
First Line	:	205 W BUCK RUN RD
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556-3815
Country	:	US
Telephone Number	:	608-921-0751
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 W. BUCK RUN ROAD
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556
Country	:	US
Telephone Number	:	608-921-0751
Fax Number	:

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

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	07/29/2014

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