Healthcare Provider Details

I. General information

NPI: 1427695147
Provider Name (Legal Business Name): KRISTI WRIGHT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2019
Last Update Date: 12/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W 5TH ST
EAST LIVERPOOL OH
43920-2849
US

IV. Provider business mailing address

747 LANG ST
EAST LIVERPOOL OH
43920-1224
US

V. Phone/Fax

Practice location:
  • Phone: 330-385-8800
  • Fax:
Mailing address:
  • Phone: 330-303-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224ZR0403X
TaxonomyDriving and Community Mobility Occupational Therapy Assistant
License Number05674
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: