Healthcare Provider Details

I. General information

NPI: 1053690693
Provider Name (Legal Business Name): JAMA RANE'E NICHOLAS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2011
Last Update Date: 08/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W WASHINGTON AVE
STERLING KS
67579-1614
US

IV. Provider business mailing address

455 W 9TH ST
HOISINGTON KS
67544-1709
US

V. Phone/Fax

Practice location:
  • Phone: 620-278-3651
  • Fax:
Mailing address:
  • Phone: 620-653-4856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18-00402
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: