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General NPI Number Information
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NPI Number | 1720210743
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Entity Type | Individual
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Provider Name | LYNETTE LOUISE REGER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 7540 N 19TH AVE SUITE 200
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City | PHOENIX
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State | AZ
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Zip | 85021-7967
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Country | US
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Telephone | 188-887-3422
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 196
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City | STOCKTON SPRINGS
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State | ME
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Zip | 04981-0196
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Country | US
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Telephone | 207-567-3604
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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 | OA2241
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License Number State | ME
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