Healthcare Provider Details

I. General information

NPI: 1730424912
Provider Name (Legal Business Name): AMBER CHRISTINE FOUST COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 05/13/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S WALNUT ST
VAN WERT OH
45891-1720
US

IV. Provider business mailing address

6037 COUNTY ROAD 424
ANTWERP OH
45813-9523
US

V. Phone/Fax

Practice location:
  • Phone: 419-359-8224
  • Fax:
Mailing address:
  • Phone: 419-786-0369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.3395
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3962HHN
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: