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General NPI Number Information
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NPI Number | 1114692464
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Entity Type | Individual
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Provider Name | KATRINA JEAN SHAW COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 634 SW MULVANE ST STE 404
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City | TOPEKA
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State | KS
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Zip | 66606-1678
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Country | US
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Telephone | 785-295-8045
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Fax | 785-231-5903
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Provider Business Mailing Address
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Address Line | 1501 SW MULVANE ST
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City | TOPEKA
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State | KS
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Zip | 66604-2715
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Country | US
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Telephone | 785-554-0003
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Fax | 785-231-5903
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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 | 18-01713
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License Number State | KS
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