Healthcare Provider Details

I. General information

NPI: 1003352337
Provider Name (Legal Business Name): ERIKA MOORE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA CRAWFORD COTA

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 CHAPEL HILL RD
COLUMBIA MO
65203-1568
US

IV. Provider business mailing address

1208 VALLEY VIEW CT
MOBERLY MO
65270-1471
US

V. Phone/Fax

Practice location:
  • Phone: 573-629-1169
  • Fax:
Mailing address:
  • Phone: 660-651-5936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2015006593
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: