Healthcare Provider Details

I. General information

NPI: 1982803375
Provider Name (Legal Business Name): KIMBERLY ANN HEJNAL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15201 OLIVE BLVD
CHESTERFIELD MO
63017-1810
US

IV. Provider business mailing address

7733 FORSYTH BLVD SUITE 2300
SAINT LOUIS MO
63105-1817
US

V. Phone/Fax

Practice location:
  • Phone: 636-532-1515
  • Fax: 636-519-7279
Mailing address:
  • Phone: 314-863-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number000361
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: