=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306275300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN ALLEN COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2013
-----------------------------------------------------
Last Update Date | 11/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 434 N WEST ST
-----------------------------------------------------
City | PERRYVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63775-1359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-728-3216
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1017 HARRY AVE
-----------------------------------------------------
City | PERRYVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63775-1146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 2012018401
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------