Healthcare Provider Details

I. General information

NPI: 1942684089
Provider Name (Legal Business Name): ABIGAIL HUFFMAN COTA, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 SHERWOOD ST SE
HUTCHINSON MN
55350-3285
US

IV. Provider business mailing address

287 N HIGH DR NW APT 210
HUTCHINSON MN
55350-2208
US

V. Phone/Fax

Practice location:
  • Phone: 320-484-6020
  • Fax:
Mailing address:
  • Phone: 320-583-2648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number201896
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: