Healthcare Provider Details

I. General information

NPI: 1942132279
Provider Name (Legal Business Name): KYLIE MCKENNA SHADOIN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962 TOMMY MUNRO DR STE A
BILOXI MS
39532-2139
US

IV. Provider business mailing address

1730 THOMAS JEFFERSON DR
BILOXI MS
39531-3304
US

V. Phone/Fax

Practice location:
  • Phone: 228-207-4393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4027
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: