Healthcare Provider Details

I. General information

NPI: 1013404888
Provider Name (Legal Business Name): KUMIKO PEOPLES COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KUMIKO KINOUCHI

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 CHARLESTOWN RD
NEW ALBANY IN
47150-9426
US

IV. Provider business mailing address

2712 HILLSIDE TER
LOUISVILLE KY
40206-2513
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-5221
  • Fax:
Mailing address:
  • Phone: 206-327-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32003271A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: