Healthcare Provider Details

I. General information

NPI: 1518923200
Provider Name (Legal Business Name): PAULETTE ANN RICHARDS COTA L BCIAC BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24820 PARADISE DRIVE
JUNCTION CITY OR
97448
US

IV. Provider business mailing address

24820 PARADISE DRIVE
JUNCTION CITY OR
97448
US

V. Phone/Fax

Practice location:
  • Phone: 541-935-7658
  • Fax:
Mailing address:
  • Phone: 541-935-7658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number247221
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberB4538
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: