Healthcare Provider Details

I. General information

NPI: 1528213733
Provider Name (Legal Business Name): DIANA LYNNE NOVOTNY COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA LYNNE SHARP COTA/L

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 EAST I
DAVID CITY NE
68632
US

IV. Provider business mailing address

2750 COUNTY ROAD A
VALPARAISO NE
68065
US

V. Phone/Fax

Practice location:
  • Phone: 402-367-3045
  • Fax:
Mailing address:
  • Phone: 402-784-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number64
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: