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General NPI Number Information
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NPI Number | 1063756146
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Entity Type | Individual
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Provider Name | LISE KETTERER COTA. NHA
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 2750 KITTYHAWK RD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-1441
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Country | US
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Telephone | 949-813-8637
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Fax |
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Provider Business Mailing Address
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Address Line | 3578 HARTSEL DR # E-335
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-2103
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Country | US
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Telephone | 949-813-8637
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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 | OTA.0000024
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License Number State | CO
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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 | 2214
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | NHA.0002857
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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