Healthcare Provider Details

I. General information

NPI: 1508173659
Provider Name (Legal Business Name): CHRISTINE MARIE WEST COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 VIRGINIA ST
MERRILLVILLE IN
46410-6231
US

IV. Provider business mailing address

151 SPRINGWOOD DR
HEBRON IN
46341-7214
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-9009
  • Fax:
Mailing address:
  • Phone: 219-545-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32001877A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: