Healthcare Provider Details

I. General information

NPI: 1508078395
Provider Name (Legal Business Name): LORRAINE SIMMONS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8128 FLORIDA BLVD
DENHAM SPRINGS LA
70726
US

IV. Provider business mailing address

34386 HIGHWAY 43
INDEPENDENCE LA
70443
US

V. Phone/Fax

Practice location:
  • Phone: 225-791-8666
  • Fax: 225-791-2891
Mailing address:
  • Phone: 985-878-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTAZ20491
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: