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General NPI Number Information
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NPI Number | 1295188696
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Entity Type | Individual
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Provider Name | BRANDI TANNER COTA
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Gender | Female
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 503 S 18TH ST
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City | LARAMIE
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State | WY
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Zip | 82070
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Country | US
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Telephone | 575-430-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 1075 N MCCUE ST # B201
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City | LARAMIE
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State | WY
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Zip | 82072-6771
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Country | US
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Telephone | 575-430-6020
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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 | 3340
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License Number State | NM
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