Healthcare Provider Details

I. General information

NPI: 1023309168
Provider Name (Legal Business Name): ABIGAIL L MERKLEY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2011
Last Update Date: 04/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W WILLOW RD
DALE IN
47523-8947
US

IV. Provider business mailing address

PO BOX 315
DALE IN
47523-0315
US

V. Phone/Fax

Practice location:
  • Phone: 812-937-4489
  • Fax:
Mailing address:
  • Phone: 812-937-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32001947A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: