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General NPI Number Information
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NPI Number | 1508367681
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Entity Type | Individual
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Provider Name | MELISSA ANN KIRN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 3431 FOOTHILL BLVD
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City | OAKLAND
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State | CA
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Zip | 94601-3129
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Country | US
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Telephone | 510-534-8540
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 W WARNER AVE UNIT 2
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City | CHICAGO
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State | IL
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Zip | 60613-1912
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Country | US
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Telephone | 219-670-3515
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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 | OTA4782
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057.004468
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License Number State | IL
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