Healthcare Provider Details

I. General information

NPI: 1891130456
Provider Name (Legal Business Name): ROBERT MCCLINTOCK COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5079 SCOTTSVILLE RD
BOWLING GREEN KY
42104-7897
US

IV. Provider business mailing address

8625 BROWNSVILLE RD
MORGANTOWN KY
42261
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-2462
  • Fax:
Mailing address:
  • Phone: 270-662-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberKY-A3020
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: