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General NPI Number Information
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NPI Number | 1255985040
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Entity Type | Individual
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Provider Name | KALLIE MAREE COY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 7689 SAGAMORE HILLS BLVD
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City | NORTHFIELD
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State | OH
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Zip | 44067-2960
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Country | US
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Telephone | 440-424-5839
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Fax |
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Provider Business Mailing Address
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Address Line | 7420 AVON DR
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City | MENTOR
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State | OH
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Zip | 44060-5210
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Country | US
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Telephone | 937-631-9119
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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 | OTA007585
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License Number State | OH
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