Healthcare Provider Details

I. General information

NPI: 1013131762
Provider Name (Legal Business Name): KAREN M SNYDER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN M LACKIE COTA

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N 64TH ST
BELLEVILLE IL
62223-3808
US

IV. Provider business mailing address

115 TILLMAN LN
BELL BUCKLE TN
37020-4039
US

V. Phone/Fax

Practice location:
  • Phone: 618-397-8400
  • Fax:
Mailing address:
  • Phone: 618-795-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2005007868
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057002697
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number919
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: