Healthcare Provider Details

I. General information

NPI: 1073450391
Provider Name (Legal Business Name): CHLOE ROY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 2ND ST STE D
JASPER IN
47546-3249
US

IV. Provider business mailing address

897 S COUNTY ROAD 175 E
WINSLOW IN
47598-8653
US

V. Phone/Fax

Practice location:
  • Phone: 812-996-0682
  • Fax:
Mailing address:
  • Phone: 812-491-3856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32003734A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: