Healthcare Provider Details

I. General information

NPI: 1952585234
Provider Name (Legal Business Name): LORA MICHELLE ESPINO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2007
Last Update Date: 12/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 N 19TH AVE STE 200
PHOENIX AZ
85021-7967
US

IV. Provider business mailing address

511 ARENA DR
PECULIAR MO
64078-9408
US

V. Phone/Fax

Practice location:
  • Phone: 888-873-4221
  • Fax:
Mailing address:
  • Phone: 816-779-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number00912
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: