Healthcare Provider Details

I. General information

NPI: 1972719326
Provider Name (Legal Business Name): REBECCA LORRAINE HAFFORD COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 W. FIFTH ST.
LACENTER KY
42056-0269
US

IV. Provider business mailing address

1608 PEARL ST
ELDORADO IL
62930
US

V. Phone/Fax

Practice location:
  • Phone: 270-665-5681
  • Fax:
Mailing address:
  • Phone: 931-581-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberKY-A2497
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: