Healthcare Provider Details

I. General information

NPI: 1831641547
Provider Name (Legal Business Name): LOUISE HERBIG COTA-L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 HERITAGE DR
SAINT PAUL NE
68873-3618
US

IV. Provider business mailing address

1819 EAGLE RD
SAINT PAUL NE
68873-3443
US

V. Phone/Fax

Practice location:
  • Phone: 308-754-5486
  • Fax:
Mailing address:
  • Phone: 308-379-2857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number967
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: