Healthcare Provider Details

I. General information

NPI: 1750136263
Provider Name (Legal Business Name): HAYLEY ELLEN FRYE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 N MAIN ST
FRANKLIN IN
46131-1251
US

IV. Provider business mailing address

6733 EVERBLOOM LN
INDIANAPOLIS IN
46217-9113
US

V. Phone/Fax

Practice location:
  • Phone: 812-343-2797
  • Fax:
Mailing address:
  • Phone: 317-523-4766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32003846A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: