Healthcare Provider Details

I. General information

NPI: 1326634163
Provider Name (Legal Business Name): EMILY ANN RICKARD COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 BEENY RD
MANITOU KY
42436-9633
US

IV. Provider business mailing address

313 BEENY RD
MANITOU KY
42436-9633
US

V. Phone/Fax

Practice location:
  • Phone: 270-871-9408
  • Fax:
Mailing address:
  • Phone: 270-871-9408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number136738
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: