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General NPI Number Information
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NPI Number | 1699696054
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Entity Type | Individual
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Provider Name | JORDAN CASTRO COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 5000 N 22ND ST
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City | OZARK
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State | MO
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Zip | 65721-5116
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Country | US
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Telephone | 417-319-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 S 13TH AVE
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City | OZARK
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State | MO
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Zip | 65721-8665
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Country | US
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Telephone | 925-399-2358
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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 | 2026027254
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License Number State | MO
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