Healthcare Provider Details

I. General information

NPI: 1841751112
Provider Name (Legal Business Name): SHANNON RENEE JAROSIK COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON BARTELS

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 W A ST
HASTINGS NE
68901-5650
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 402-461-7578
  • Fax: 402-461-7509
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number973
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: