1841370624 NPI number — MRS. JODI LYNN NEEDHAM COTA

Table of content: MRS. JODI LYNN NEEDHAM COTA (NPI 1841370624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841370624 NPI number — MRS. JODI LYNN NEEDHAM COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEEDHAM
Provider First Name:
JODI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORDTS
Provider Other First Name:
JODI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
COTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841370624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 371
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WONEWOC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-464-7690
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 WATER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-489-8260
Provider Business Practice Location Address Fax Number:
608-489-8193
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  1367027 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 693182 . This is a "DPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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