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General NPI Number Information
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NPI Number | 1497144687
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Entity Type | Individual
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Provider Name | SAMANTHA M WOODS COTA
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Gender | Female
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 455 THELMA DR
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City | CASPER
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State | WY
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Zip | 82609-2324
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Country | US
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Telephone | 307-472-3327
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Fax |
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Provider Business Mailing Address
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Address Line | 1714 WESTRIDGE WAY
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City | CASPER
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State | WY
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Zip | 82604-3307
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Country | US
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Telephone | 307-215-6694
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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 | 1028
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License Number State | WY
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