Healthcare Provider Details

I. General information

NPI: 1467257220
Provider Name (Legal Business Name): BRIANNA LYNN KIRSCH COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 COUNTRY CLUB RD
FAIRMONT WV
26554-1306
US

IV. Provider business mailing address

2017 TANGLEWOOD RD
BRIDGEPORT WV
26330-9381
US

V. Phone/Fax

Practice location:
  • Phone: 304-366-9100
  • Fax:
Mailing address:
  • Phone: 814-414-9431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2565
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberC2565
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: