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General NPI Number Information
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NPI Number | 1144043308
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Entity Type | Individual
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Provider Name | JENNY SUE BROWN COTA
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Gender | Female
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 449 S FITNESS PL
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City | EAGLE
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State | ID
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Zip | 83616-6828
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Country | US
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Telephone | 208-957-6301
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Fax |
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Provider Business Mailing Address
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Address Line | 5940 W PORT LN APT 103
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City | BOISE
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State | ID
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Zip | 83703-4892
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Country | US
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Telephone | 208-317-6268
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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-2976
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License Number State | ID
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