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General NPI Number Information
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NPI Number | 1275113359
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Entity Type | Individual
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Provider Name | RITA VILLARREAL COTA/L
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Gender | Female
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 639 S MAIZE CT
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City | WICHITA
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State | KS
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Zip | 67209-1337
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Country | US
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Telephone | 316-425-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1540 EAST ST
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City | ANDOVER
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State | KS
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Zip | 67002-9559
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Country | US
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Telephone | 316-880-9392
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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 | 18-01602
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License Number State | KS
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