Healthcare Provider Details

I. General information

NPI: 1033513304
Provider Name (Legal Business Name): THOMAS HOBSON COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N HURSTBOURNE PKWY SUITE 200
LOUISVILLE KY
40222-5185
US

IV. Provider business mailing address

620 9TH ST SW
DEMOTTE IN
46310-9365
US

V. Phone/Fax

Practice location:
  • Phone: 502-412-5847
  • Fax:
Mailing address:
  • Phone: 219-308-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32002055A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: