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General NPI Number Information
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NPI Number | 1467153015
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Entity Type | Individual
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Provider Name | KRISTINA KATE SPANGLER COTA
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Gender | Female
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Dates
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Enumeration Date | 03/10/2023
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 502 N STATE ST
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City | FRANKLIN GROVE
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State | IL
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Zip | 61031-9773
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Country | US
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Telephone | 815-456-2374
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Fax |
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Provider Business Mailing Address
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Address Line | 519 2ND AVE
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City | DIXON
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State | IL
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Zip | 61021-1911
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Country | US
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Telephone | 779-861-3882
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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 | 057004828
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License Number State | IL
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