Healthcare Provider Details

I. General information

NPI: 1578874947
Provider Name (Legal Business Name): JENNIFER KOBITZ COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 OLD COVINGTON HWY
HAMMOND LA
70403-5126
US

IV. Provider business mailing address

21786 ROSEMOUND LANE
SPRINGFIELD LA
70462
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-9030
  • Fax:
Mailing address:
  • Phone: 225-294-3053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberZ20334
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: