Healthcare Provider Details

I. General information

NPI: 1467863910
Provider Name (Legal Business Name): MICHELLE PARTRIDGE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS MICHELLE DAWN BUDREAU

II. Dates (important events)

Enumeration Date: 05/17/2014
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date: 12/14/2018
Reactivation Date: 03/26/2019

III. Provider practice location address

221 S WASHINGTON AVE
WELLINGTON KS
67152-3037
US

IV. Provider business mailing address

BUILDING 2200, 3500 N. ROCK RD. #101
WICHITA KS
67226
US

V. Phone/Fax

Practice location:
  • Phone: 620-326-4300
  • Fax:
Mailing address:
  • Phone: 316-440-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18-00962
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: