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General NPI Number Information
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NPI Number | 1932316759
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Entity Type | Individual
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Provider Name | REMICK LEI HARDY COTA
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1130 ALLUMBAUGH ST
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City | BOISE
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State | ID
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Zip | 83704-8700
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Country | US
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Telephone | 208-870-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 7077 USTICK RD
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City | BOISE
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State | ID
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Zip | 83704-6037
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Country | US
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Telephone | 208-870-2001
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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 | OTA-115
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License Number State | ID
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