Healthcare Provider Details

I. General information

NPI: 1508144072
Provider Name (Legal Business Name): KAREN KAY DRIESSEN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W 36TH ST
SCOTTSBLUFF NE
69361-4636
US

IV. Provider business mailing address

4402 APPLE AVE
SCOTTSBLUFF NE
69361-4849
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-2019
  • Fax:
Mailing address:
  • Phone: 701-202-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number842
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: