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General NPI Number Information
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NPI Number | 1457064461
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Entity Type | Individual
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Provider Name | ERIN MICHELLE ROSS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 15950 MANCHESTER RD
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City | ELLISVILLE
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State | MO
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Zip | 63011-2170
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Country | US
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Telephone | 636-552-4890
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Fax |
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Provider Business Mailing Address
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Address Line | 873 SAINT ANDREWS DR
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City | UNION
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State | MO
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Zip | 63084-4475
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Country | US
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Telephone | 636-584-9080
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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 | 2015044597
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License Number State | MO
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