Healthcare Provider Details

I. General information

NPI: 1619304797
Provider Name (Legal Business Name): EMILY J E SPINNER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 ELI PL
NEWBURGH IN
47630-7436
US

IV. Provider business mailing address

606 S MAIN ST
HUNTINGBURG IN
47542-9606
US

V. Phone/Fax

Practice location:
  • Phone: 812-858-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32002512A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: