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General NPI Number Information
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NPI Number | 1922300458
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Entity Type | Individual
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Provider Name | PAMELA LOUISE SIMON COTA
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Gender | Female
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Dates
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Enumeration Date | 12/04/2010
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Last Update Date | 12/04/2010
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Provider Practice Location Address
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Address Line | 1574 STATE ROAD 502
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City | SANTA FE
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State | NM
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Zip | 87506-2697
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Country | US
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Telephone | 812-267-0163
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 86
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City | DEPAUW
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State | IN
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Zip | 47115-0086
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Country | US
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Telephone | 812-267-0163
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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 | 2747
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License Number State | NM
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