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General NPI Number Information
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NPI Number | 1457911661
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Entity Type | Individual
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Provider Name | MARIAH SUSAN KIRCHER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 35105 KENAI SPUR HWY
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City | SOLDOTNA
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State | AK
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Zip | 99669-7658
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Country | US
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Telephone | 907-262-7800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1138
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City | KENAI
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State | AK
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Zip | 99611-1138
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Country | US
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Telephone | 360-481-2511
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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 | 144712
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License Number State | AK
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