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General NPI Number Information
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NPI Number | 1790191146
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Entity Type | Individual
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Provider Name | KATLYN ELIZABETH FREY COTA
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Gender | Female
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 303 N. HURSTBOURNE PARKWAY SUITE 200 PARAGON REHABILITATION
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City | LOUISVILLE
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State | KY
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Zip | 40222
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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 | 171 TYLER AVE. APT. #7
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City | HARRODSBURG
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State | KY
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Zip | 40330
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Country | US
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Telephone | 618-697-5107
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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 | KY-A5940
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057.003846
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 212660
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License Number State | TX
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