Healthcare Provider Details

I. General information

NPI: 1497012355
Provider Name (Legal Business Name): ARTHUR L BURGER COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 E MOORES PIKE
BLOOMINGTON IN
47401-7129
US

IV. Provider business mailing address

221 BRIARWOOD LN
BEDFORD IN
47421-7243
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-7604
  • Fax: 812-334-7705
Mailing address:
  • Phone: 812-675-6826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32000454A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: