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General NPI Number Information
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NPI Number | 1700227451
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Entity Type | Individual
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Provider Name | ANGELA MARIE WALLS COTA
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Gender | Female
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 303 N HURSTBOURNE PKWY SUITE 200
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City | LOUISVILLE
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State | KY
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Zip | 40222-5185
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Country | US
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Telephone | 502-412-5847
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Fax |
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Provider Business Mailing Address
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Address Line | 3534 TRAILSTONE DR
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City | EVANSVILLE
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State | IN
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Zip | 47725-8184
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Country | US
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Telephone | 812-345-5110
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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 | 32001832A
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License Number State | IN
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