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General NPI Number Information
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NPI Number | 1790126472
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Entity Type | Individual
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Provider Name | LINDSAY BROOKE MONTGOMERY 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 | 1432 DEPEW ST
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City | LAKEWOOD
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State | CO
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Zip | 80214-2237
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Country | US
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Telephone | 303-238-4828
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Fax |
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Provider Business Mailing Address
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Address Line | 260 NORSE ST
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City | GOLDEN
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State | CO
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Zip | 80401-5522
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Country | US
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Telephone | 303-656-1029
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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 | 310764
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License Number State | CO
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