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General NPI Number Information
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NPI Number | 1083379770
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Entity Type | Individual
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Provider Name | KELSEY RAY COTA BSRT CT
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Gender | Female
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 200 HAWKINS DR
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City | IOWA CITY
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State | IA
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Zip | 52242-1009
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Country | US
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Telephone | 319-384-6147
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Fax |
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Provider Business Mailing Address
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Address Line | 808 5TH ST APT 309
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City | CORALVILLE
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State | IA
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Zip | 52241-2336
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Country | US
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Telephone | 563-419-0239
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | RAD105419
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License Number State | IA
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