Healthcare Provider Details

I. General information

NPI: 1134925399
Provider Name (Legal Business Name): KYLEE ELIZABETH VAAL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MEDICAL DR
CARMEL IN
46032-3323
US

IV. Provider business mailing address

1371 N HAYLAND DR
JASPER IN
47546-9093
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-4211
  • Fax:
Mailing address:
  • Phone: 812-827-4192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32003914A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: