Healthcare Provider Details

I. General information

NPI: 1326440306
Provider Name (Legal Business Name): CORINNA VOMUND COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 ABERDEEN CT
SAINT CHARLES MO
63303-3860
US

IV. Provider business mailing address

1629 ABERDEEN CT
SAINT CHARLES MO
63303-3860
US

V. Phone/Fax

Practice location:
  • Phone: 636-328-4665
  • Fax:
Mailing address:
  • Phone: 636-328-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number330500
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: