Healthcare Provider Details

I. General information

NPI: 1093059289
Provider Name (Legal Business Name): TERRI KUHNERT COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W MILL ST
CARBONDALE IL
62901-2727
US

IV. Provider business mailing address

744 INDIAN TRAIL DR
PINCKNEYVILLE IL
62274-1925
US

V. Phone/Fax

Practice location:
  • Phone: 618-529-3060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.002237
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: