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General NPI Number Information
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NPI Number | 1013391341
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Entity Type | Individual
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Provider Name | DIANE GREGORY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/19/2015
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Provider Practice Location Address
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Address Line | 2000 BOARDWALK PLACE DR
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City | O FALLON
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State | MO
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Zip | 63368-3900
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Country | US
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Telephone | 618-292-2780
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Fax |
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Provider Business Mailing Address
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Address Line | 3985 MARIETTA DR
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City | FLORISSANT
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State | MO
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Zip | 63033-3214
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Country | US
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Telephone | 314-852-4565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2014024930
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057.004125
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License Number State | IL
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