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General NPI Number Information
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NPI Number | 1437923422
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Entity Type | Individual
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Provider Name | MORIAH NICOLE SUE BROOKS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 501 SE 12TH ST
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City | OAK GROVE
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State | MO
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Zip | 64075-9384
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Country | US
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Telephone | 816-690-4153
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 S SAINT LOUIS ST
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City | CONCORDIA
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State | MO
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Zip | 64020-9620
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Country | US
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Telephone | 660-525-4566
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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 | 2023031911
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License Number State | MO
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