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General NPI Number Information
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NPI Number | 1811641723
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Entity Type | Individual
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Provider Name | ANNA KATHRYN BAIONI COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 5140 GALAXIE DR
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City | JACKSON
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State | MS
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Zip | 39206-4335
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Country | US
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Telephone | 662-714-3122
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Fax | 888-228-1594
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Provider Business Mailing Address
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Address Line | 2144 LAKESHORE DR APT 7C
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City | RIDGELAND
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State | MS
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Zip | 39157-1028
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Country | US
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Telephone | 662-588-2295
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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 | TA3710
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License Number State | MS
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