Healthcare Provider Details

I. General information

NPI: 1336324854
Provider Name (Legal Business Name): ERIN CIOCARLAN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 E 15TH ST
CASPER WY
82609-4126
US

IV. Provider business mailing address

2521 E 15TH ST
CASPER WY
82609-4126
US

V. Phone/Fax

Practice location:
  • Phone: 307-237-7444
  • Fax:
Mailing address:
  • Phone: 307-237-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number621
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: