Healthcare Provider Details

I. General information

NPI: 1265343370
Provider Name (Legal Business Name): JENNIFER DUNCAN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WILDCAT PRIDE DR
CUBA MO
65453-1549
US

IV. Provider business mailing address

1379 OAKRIDGE ESTATES DR
SAINT CLAIR MO
63077-2327
US

V. Phone/Fax

Practice location:
  • Phone: 573-885-2534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2018013862
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: