Healthcare Provider Details

I. General information

NPI: 1669606034
Provider Name (Legal Business Name): BRITTANY CHANELL BARD COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HIGH ST
BOWLING GREEN KY
42101-1746
US

IV. Provider business mailing address

620 HOLT RD
CENTRAL CITY KY
42330-5302
US

V. Phone/Fax

Practice location:
  • Phone: 270-843-3296
  • Fax:
Mailing address:
  • Phone: 270-843-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA4180
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: