1427484922 NPI number — MRS. MICHELLE LYNN KOTARSKI PTA

Table of content: MRS. MICHELLE LYNN KOTARSKI PTA (NPI 1427484922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427484922 NPI number — MRS. MICHELLE LYNN KOTARSKI PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOTARSKI
Provider First Name:
MICHELLE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZINDA
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PTA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1427484922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2626 N 76TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUWATOSA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53213-1137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-774-7794
Provider Business Mailing Address Fax Number:
414-607-3971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 N GRANDVIEW BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53188-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-774-7794
Provider Business Practice Location Address Fax Number:
414-607-3971
Provider Enumeration Date:
09/17/2013

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: 225200000X , with the licence number:  1226-19 , 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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