Healthcare Provider Details

I. General information

NPI: 1528304078
Provider Name (Legal Business Name): KAREN MARIE HYATT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 COOKS HILL RD
CENTRALIA WA
98531
US

IV. Provider business mailing address

914 S. SCHEUBER RD REHAB THERAPIES
CENTRALIA WA
98531
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-8720
  • Fax: 360-330-8737
Mailing address:
  • Phone: 360-330-8720
  • Fax: 360-330-8737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOC60307739
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: