Healthcare Provider Details

I. General information

NPI: 1396093456
Provider Name (Legal Business Name): ROBYN MARIE KOCH COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 3RD ST
LARAMIE WY
82072-2514
US

IV. Provider business mailing address

1452 N 2ND ST
LARAMIE WY
82072-2006
US

V. Phone/Fax

Practice location:
  • Phone: 307-742-6641
  • Fax:
Mailing address:
  • Phone: 307-277-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberCOTA-911
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: