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General NPI Number Information
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NPI Number | 1295079101
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Entity Type | Individual
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Provider Name | KELLEY KYRENE MILLER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 313 N. HURSTBOURNE PARKWAY SUITE 211
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City | LOUISVILLE
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State | KY
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Zip | 41222
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Country | US
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Telephone | 512-412-5847
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Fax |
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Provider Business Mailing Address
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Address Line | 11700 ALPINE HWY
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City | FRAZEYSBURG
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State | OH
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Zip | 43822-9382
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Country | US
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Telephone |
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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 | 03914
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License Number State | OH
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