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General NPI Number Information
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NPI Number | 1497563795
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Entity Type | Individual
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Provider Name | AMANDA SLATER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 1773 W SPRINGFIELD RD
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City | SAINT CLAIR
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State | MO
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Zip | 63077-4420
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Country | US
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Telephone | 636-629-3571
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Fax |
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Provider Business Mailing Address
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Address Line | 427 CADDY CT
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City | SAINT CLAIR
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State | MO
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Zip | 63077-2466
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Country | US
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Telephone | 314-606-4138
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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 | 2024045473
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License Number State | MO
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