Provider Demographics
NPI:1124188560
Name:KOEBE, ANGELA M (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:KOEBE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1326 CROOKS ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3821
Mailing Address - Country:US
Mailing Address - Phone:920-436-9059
Mailing Address - Fax:
Practice Address - Street 1:2900 CURRY LN
Practice Address - Street 2:NEW CURATIVE REHABILITAION, INC.
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5857
Practice Address - Country:US
Practice Address - Phone:920-468-1161
Practice Address - Fax:920-965-2653
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1899-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant