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General NPI Number Information
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NPI Number | 1447471735
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Entity Type | Individual
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Provider Name | TRACI D CLARK COTA
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 910 W WALNUT ST
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City | ALBANY
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State | IN
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Zip | 47320-1530
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Country | US
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Telephone | 765-789-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 5218 S MOUNT PLEASANT RD
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City | PORTLAND
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State | IN
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Zip | 47371-7201
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Country | US
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Telephone | 260-726-2433
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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 |
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License Number State | IN
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