Healthcare Provider Details

I. General information

NPI: 1073779369
Provider Name (Legal Business Name): CAROL MARIE KENNY COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 HAMILTON AVE
CINCINNATI OH
45231-2321
US

IV. Provider business mailing address

1763 MARSHVIEW CT
HEBRON KY
41048-7366
US

V. Phone/Fax

Practice location:
  • Phone: 513-931-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number02702
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: