Healthcare Provider Details

I. General information

NPI: 1245690767
Provider Name (Legal Business Name): WHITNEY WHITAKER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 STUART NELSON PARK RD
PADUCAH KY
42001-9678
US

IV. Provider business mailing address

1012 OLD FREDONIA RD
PRINCETON KY
42445-6071
US

V. Phone/Fax

Practice location:
  • Phone: 270-442-9502
  • Fax:
Mailing address:
  • Phone: 270-963-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number137645
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: