Healthcare Provider Details

I. General information

NPI: 1396069589
Provider Name (Legal Business Name): NICOLE IRENE POLLARD COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 MEDWELL DRIVE
NEWBURGH IN
47630
US

IV. Provider business mailing address

1320 GREENFIELD RD
EVANSVILLE IN
47715-5141
US

V. Phone/Fax

Practice location:
  • Phone: 812-853-2993
  • Fax:
Mailing address:
  • Phone: 812-401-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32001711A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: