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General NPI Number Information
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NPI Number | 1417683251
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Entity Type | Individual
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Provider Name | ELIZABETH ANN KENNEDY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 2211 LOMAS BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2719
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Country | US
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Telephone | 505-476-4940
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 E 30TH ST
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City | TUCSON
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State | AZ
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Zip | 85710-8004
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Country | US
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Telephone | 520-861-2089
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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 | OC.61335296
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA-006410
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License Number State |
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Taxonomy #3
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 61335296
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License Number State | WA
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