Healthcare Provider Details

I. General information

NPI: 1144425273
Provider Name (Legal Business Name): JAMIE GATZ COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 W GRAND ST
GALLATIN MO
64640-8320
US

IV. Provider business mailing address

PO BOX 262
SAINT CHARLES MO
63302-0262
US

V. Phone/Fax

Practice location:
  • Phone: 660-663-2197
  • Fax:
Mailing address:
  • Phone: 314-210-4195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2007010888
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: