Healthcare Provider Details

I. General information

NPI: 1457683039
Provider Name (Legal Business Name): STEFANIE RAY COLE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEFANIE R KELLEY COTA

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 W US 40
GREENFIELD IN
46140-8803
US

IV. Provider business mailing address

9125 WASHINGTON BLVD
INDIANAPOLIS IN
46240-1061
US

V. Phone/Fax

Practice location:
  • Phone: 317-894-3301
  • Fax:
Mailing address:
  • Phone: 812-455-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number99041100A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: