Healthcare Provider Details

I. General information

NPI: 1447823778
Provider Name (Legal Business Name): ELIZABETH MCGEHEE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 CHICKESAW ST
SENECA MO
64865-9281
US

IV. Provider business mailing address

108 JUDD ST
GRANBY MO
64844-8122
US

V. Phone/Fax

Practice location:
  • Phone: 417-776-8041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2020000943
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: