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General NPI Number Information
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NPI Number | 1932445541
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Entity Type | Individual
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Provider Name | JENNIFER LANE RYLEN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 905 HIGHWAY 127 N
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City | OWENTON
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State | KY
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Zip | 40359-9302
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Country | US
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Telephone | 502-484-0661
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Fax |
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Provider Business Mailing Address
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Address Line | 2321 18 MILE CREEK RD
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City | WESTPORT
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State | KY
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Zip | 40077-9701
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Country | US
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Telephone | 502-222-0098
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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 | A3659
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License Number State | KY
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