Healthcare Provider Details

I. General information

NPI: 1023816667
Provider Name (Legal Business Name): CARRIE PARRISH COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S 3RD ST
ODESSA MO
64076-1453
US

IV. Provider business mailing address

3100 S BLACK FOREST AVE
BLUE SPRINGS MO
64015-1119
US

V. Phone/Fax

Practice location:
  • Phone: 816-633-5316
  • Fax:
Mailing address:
  • Phone: 816-519-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number005065
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: