Healthcare Provider Details

I. General information

NPI: 1952730368
Provider Name (Legal Business Name): KARI MARIE MOORMAN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CHURCH ST 3RD FLOOR
PHILADELPHIA PA
19106-4518
US

IV. Provider business mailing address

7898 E SAINT NICHOLAS ST
GREENSBURG IN
47240-8875
US

V. Phone/Fax

Practice location:
  • Phone: 800-974-6383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP007586
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32002127A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number212319
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: