Healthcare Provider Details

I. General information

NPI: 1528326535
Provider Name (Legal Business Name): YOSHIMI ZOELLER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LAURA SUE HUMPHRESS DR
CAMPBELLSVILLE KY
42718-8899
US

IV. Provider business mailing address

8126 LAKE TER APT G10
LOUISVILLE KY
40222-7328
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-7768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA4739
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: