Healthcare Provider Details

I. General information

NPI: 1114072717
Provider Name (Legal Business Name): KURT LAMMERS COTA L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 GRANT DR STE A
RENO NV
89509-7349
US

IV. Provider business mailing address

1285 AKARD DR
RENO NV
89503-3117
US

V. Phone/Fax

Practice location:
  • Phone: 775-829-4700
  • Fax: 775-829-4710
Mailing address:
  • Phone: 775-787-7046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1130
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: