Healthcare Provider Details

I. General information

NPI: 1851670459
Provider Name (Legal Business Name): ELIZABETH ELLEN KERL COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 RIPPLE CREEK DR
ELSMERE KY
41018
US

IV. Provider business mailing address

501 RIPPLE CREEK DR
ELSMERE KY
41018-2695
US

V. Phone/Fax

Practice location:
  • Phone: 859-322-0148
  • Fax:
Mailing address:
  • Phone: 859-322-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: