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General NPI Number Information
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NPI Number | 1639525918
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Entity Type | Individual
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Provider Name | LAURIE GORACKE COTA
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Gender | Female
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 601 CROSS ST
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City | BURLINGTON
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State | KS
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Zip | 66839-1105
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Country | US
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Telephone | 620-364-2117
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Fax |
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Provider Business Mailing Address
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Address Line | 805 N C ST
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City | LE ROY
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State | KS
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Zip | 66857-9522
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Country | US
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Telephone | 620-228-3127
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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 | 1801001
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License Number State | KS
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