Healthcare Provider Details

I. General information

NPI: 1437066321
Provider Name (Legal Business Name): VANESSA KIRSTEN KOTIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 JONES AVE
DRACUT MA
01826-1503
US

IV. Provider business mailing address

43 CAMPAW ST
LOWELL MA
01850-1006
US

V. Phone/Fax

Practice location:
  • Phone: 978-907-3496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberSA3731788
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: