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General NPI Number Information
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NPI Number | 1518787324
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Entity Type | Individual
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Provider Name | JENNIFER LEIGH VAUGHN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 427 W CHESTNUT ST
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City | KAHOKA
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State | MO
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Zip | 63445-1314
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Country | US
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Telephone | 660-727-2377
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Fax |
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Provider Business Mailing Address
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Address Line | 511 W LAFAYETTE ST
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City | PALMYRA
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State | MO
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Zip | 63461-1481
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Country | US
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Telephone |
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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 | 057004582
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License Number State | MO
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