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General NPI Number Information
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NPI Number | 1134437882
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Entity Type | Individual
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Provider Name | LAUREN A CORN COTA
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Gender | Female
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 365 MCKNIGHT AVE
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City | WEST FORK
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State | AR
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Zip | 72774-3144
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Country | US
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Telephone | 479-839-3030
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Fax | 479-839-3045
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Provider Business Mailing Address
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Address Line | 8107 MADISON AVE
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City | KANSAS CITY
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State | MO
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Zip | 64114-2231
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Country | US
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Telephone | 870-784-0821
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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 | OT-A611
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License Number State | AR
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