Healthcare Provider Details

I. General information

NPI: 1760894364
Provider Name (Legal Business Name): ELIZABETH AKERS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2014
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS WAY
MEXICO MO
65265-3379
US

IV. Provider business mailing address

3868 COUNTY ROAD 144
WILLIAMSBURG MO
63388-1305
US

V. Phone/Fax

Practice location:
  • Phone: 660-438-6993
  • Fax:
Mailing address:
  • Phone: 573-418-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2014002577
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: