Healthcare Provider Details

I. General information

NPI: 1487992020
Provider Name (Legal Business Name): KATHY MASSEY COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 N KLEIN CIR
DERBY KS
67037-7011
US

IV. Provider business mailing address

6459 S EAGLE DR
DERBY KS
67037-9039
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-9619
  • Fax:
Mailing address:
  • Phone: 316-737-5337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18-00566
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: