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General NPI Number Information
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NPI Number | 1649583824
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Entity Type | Individual
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Provider Name | EDDIE LEELOVE KUYKENDALL III COTA
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Gender | Male
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 12/10/2013
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Provider Practice Location Address
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Address Line | 13835 N TATUM BLVD STE 9-429
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City | PHOENIX
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State | AZ
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Zip | 85032-5590
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Country | US
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Telephone | 480-242-5903
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Fax |
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Provider Business Mailing Address
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Address Line | 7519 N 47TH LN
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City | GLENDALE
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State | AZ
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Zip | 85301-1576
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Country | US
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Telephone | 602-301-5592
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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 | 3353
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License Number State | AZ
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