Healthcare Provider Details

I. General information

NPI: 1982054110
Provider Name (Legal Business Name): AMBER WILLIAMS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2016
Last Update Date: 06/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 OAK ST
LA CROSSE KS
67548-9798
US

IV. Provider business mailing address

1017 OAK ST
LA CROSSE KS
67548-9798
US

V. Phone/Fax

Practice location:
  • Phone: 785-569-1140
  • Fax:
Mailing address:
  • Phone: 785-569-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18-01279
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: