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General NPI Number Information
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NPI Number | 1447419031
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Entity Type | Individual
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Provider Name | MARY JANE DARNELL COTA
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Gender | Female
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 2607 MAIN STREET
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City | BENTON
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State | KY
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Zip | 42025
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Country | US
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Telephone | 270-527-0147
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Fax |
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Provider Business Mailing Address
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Address Line | 2607 MAIN STREET
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City | BENTON
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State | KY
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Zip | 42025
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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 | KY-A3613
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License Number State | KY
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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 | 057.002750
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License Number State | IL
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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 | 2006019734
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License Number State | MO
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