Healthcare Provider Details

I. General information

NPI: 1912311739
Provider Name (Legal Business Name): ALICIA TAYLOR COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 ELI PL
NEWBURGH IN
47630-7436
US

IV. Provider business mailing address

3800 ELI PL
NEWBURGH IN
47630-7436
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32002640A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: