Most Relevant Information
Provider Data
| NPI Number: | 1003569815 |
| Provider Name: | TYLER CHRISTIAN MOGENSEN COTA |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | 5652 |
Most Important Dates
| Enumeration Date: | 02/01/2022 |
| Last Updated: | 02/01/2022 |
Provider Practice Location
325 E FLORIDA AVE
APPLETON
WI
549111325
Practice Location Phone/Fax
| Phone: | 9207317310 |
| Fax: |
Provider Mailing Location
325 E FLORIDA AVE
APPLETON
WI
549111325
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |