=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598573198
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLENNA LYNNE UY CURIOSO COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2024
-----------------------------------------------------
Last Update Date | 12/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94-1181 KA UKA BLVD STE C
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-4485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-260-9056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95-1009 HALEMALU ST
-----------------------------------------------------
City | MILILANI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96789-5564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-591-0529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | OTA-330
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------