Healthcare Provider Details

I. General information

NPI: 1700710472
Provider Name (Legal Business Name): BREE DENISE PLENGE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S JOHNSON ST
KAHOKA MO
63445-1657
US

IV. Provider business mailing address

120 S JOHNSON ST
KAHOKA MO
63445-1657
US

V. Phone/Fax

Practice location:
  • Phone: 660-727-2722
  • Fax:
Mailing address:
  • Phone: 660-727-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2026025370
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: