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General NPI Number Information
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NPI Number | 1205284387
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Entity Type | Individual
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Provider Name | BRENNA NICHOLE GODDARD COTA
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Gender | Female
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Dates
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Enumeration Date | 05/30/2016
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Last Update Date | 05/30/2016
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Provider Practice Location Address
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Address Line | 1311 N MILDRED RD
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City | CORTEZ
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State | CO
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Zip | 81321-2231
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Country | US
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Telephone | 970-564-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 521 N BEECH ST
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City | CORTEZ
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State | CO
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Zip | 81321-2114
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Country | US
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Telephone | 785-577-1333
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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.0000756
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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 | 18-01303
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License Number State | KS
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