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General NPI Number Information
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NPI Number | 1811266687
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Entity Type | Individual
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Provider Name | JENNIFER LYNN LASLEY COTA
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Gender | Female
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 2915 STRONG AVE SPECTRUM HOME HEALTH
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City | KANSAS CITY
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State | KS
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Zip | 66106-9742
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Country | US
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Telephone | 913-831-2979
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Fax |
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Provider Business Mailing Address
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Address Line | 15516 POPLAR ST
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City | BASEHOR
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State | KS
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Zip | 66007-9742
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Country | US
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Telephone | 913-724-3161
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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 | 18-00456
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License Number State | KS
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