Healthcare Provider Details

I. General information

NPI: 1003731647
Provider Name (Legal Business Name): MAKENNA SINGH COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CORPORATE CENTRE DR
O FALLON MO
63368-8685
US

IV. Provider business mailing address

2463 VILLAGE GLEN CT
MARYLAND HEIGHTS MO
63043-1529
US

V. Phone/Fax

Practice location:
  • Phone: 636-851-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2026032131
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: