Healthcare Provider Details

I. General information

NPI: 1134083967
Provider Name (Legal Business Name): BAO NHU LE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 NW 107TH ST
KANSAS CITY MO
64154-1795
US

IV. Provider business mailing address

6126 NW 107TH ST
KANSAS CITY MO
64154-1795
US

V. Phone/Fax

Practice location:
  • Phone: 816-237-9771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2025049347
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: