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General NPI Number Information
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NPI Number | 1871990648
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Entity Type | Individual
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Provider Name | ALYSSA ANN SANDERS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 106 DIECKS DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2443
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Country | US
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Telephone | 270-737-2738
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Fax |
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Provider Business Mailing Address
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Address Line | 126 SHIPP LN
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City | GLENDALE
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State | KY
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Zip | 42740-9721
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Country | US
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Telephone | 270-735-2912
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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 | A5414
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License Number State | KY
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