Provider Demographics
NPI:1518927623
Name:GOTTA, MARIA JEAN (ATC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JEAN
Last Name:GOTTA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7329 TIMBER LAKE TRL
Mailing Address - Street 2:#302
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3714
Mailing Address - Country:US
Mailing Address - Phone:715-321-0616
Mailing Address - Fax:
Practice Address - Street 1:621 SCIENCE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1074
Practice Address - Country:US
Practice Address - Phone:608-437-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI771 - 392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer