1033668132 NPI number — MRS. KAYLA SUE WILLIAMS C.O.T.A.

Table of content: MRS. KAYLA SUE WILLIAMS C.O.T.A. (NPI 1033668132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033668132 NPI number — MRS. KAYLA SUE WILLIAMS C.O.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
KAYLA
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.O.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOFFMANN
Provider Other First Name:
KAYLA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.O.T.A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033668132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 S HOLMEN DR
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
HOLMEN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54636-9467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-526-9888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 PARK LANE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54601-7747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-789-7882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2016

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:  4731-27 , 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)





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