Healthcare Provider Details

I. General information

NPI: 1215584354
Provider Name (Legal Business Name): TARA PLOEGER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 WEISENBORN RD
SAINT JOSEPH MO
64507-2527
US

IV. Provider business mailing address

809 300TH ST
MORRILL KS
66515-9487
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-9874
  • Fax:
Mailing address:
  • Phone: 785-547-5821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1073
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: