Healthcare Provider Details

I. General information

NPI: 1093269201
Provider Name (Legal Business Name): CHLOE LYNN ZWART COTA, L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 CHESTNUT STATION CT
LOUISVILLE KY
40299-6395
US

IV. Provider business mailing address

1098 CORVETTE DR
JENISON MI
49428-9413
US

V. Phone/Fax

Practice location:
  • Phone: 800-335-1060
  • Fax:
Mailing address:
  • Phone: 616-901-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202008140
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: