Healthcare Provider Details

I. General information

NPI: 1134475783
Provider Name (Legal Business Name): KENZIE ELIZABETH ESTES COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 E MAIN ST
WEST POINT MS
39773-3137
US

IV. Provider business mailing address

2100 ENGLEWOOD DR
TUPELO MS
38801-5655
US

V. Phone/Fax

Practice location:
  • Phone: 662-494-3640
  • Fax:
Mailing address:
  • Phone: 662-401-9450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: