Healthcare Provider Details

I. General information

NPI: 1295323129
Provider Name (Legal Business Name): AMY RUTH FERNANDEZ-PARIS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 E LINCOLN ST
WICHITA KS
67218-2099
US

IV. Provider business mailing address

PO BOX 222
CUNNINGHAM KS
67035-0222
US

V. Phone/Fax

Practice location:
  • Phone: 316-686-7171
  • Fax:
Mailing address:
  • Phone: 316-617-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1800677
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number1800677
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code224ZL0004X
TaxonomyLow Vision Occupational Therapy Assistant
License Number1800677
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code224ZR0403X
TaxonomyDriving and Community Mobility Occupational Therapy Assistant
License Number1800677
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License Number1800677
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: