Healthcare Provider Details

I. General information

NPI: 1053870196
Provider Name (Legal Business Name): KELLIE SCHMIDT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 PLEASANTVIEW CT
BRADENTON FL
34211-2758
US

IV. Provider business mailing address

5575 PLEASANTVIEW CT
BRADENTON FL
34211-2758
US

V. Phone/Fax

Practice location:
  • Phone: 816-885-0497
  • Fax: 855-232-8604
Mailing address:
  • Phone: 816-885-0497
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1801434
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2015031004
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA17530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: