Healthcare Provider Details

I. General information

NPI: 1891178547
Provider Name (Legal Business Name): NATHAN SUTTON COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 FLETCHER AVE APT 7
LINCOLN NE
68521-1374
US

IV. Provider business mailing address

541 FLETCHER AVE APT 7
LINCOLN NE
68521-1374
US

V. Phone/Fax

Practice location:
  • Phone: 601-580-2480
  • Fax:
Mailing address:
  • Phone: 601-580-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number942
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: