Healthcare Provider Details

I. General information

NPI: 1336700715
Provider Name (Legal Business Name): BARBARA JEAN JOST COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. BARBARA JEAN MOSES

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GOOD SAMARITAN SIOUX FALLS VILLAGE 3901 SOUTH MARION ROAD
SIOUX FALLS SD
57106
US

IV. Provider business mailing address

2904 W 33RD STREET APT 226
SIOUX FALLS SD
57105
US

V. Phone/Fax

Practice location:
  • Phone: 605-361-3311
  • Fax: 605-362-3585
Mailing address:
  • Phone: 320-760-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number201737
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number420A
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: