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General NPI Number Information
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NPI Number | 1942512488
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Entity Type | Individual
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Provider Name | PHYLLIS FAY CAUDILL-JAMES COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 915 CARL ALLEN ST
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City | MOUNT VERNON
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State | MO
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Zip | 65712-1612
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Country | US
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Telephone | 417-461-7018
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Fax | 417-461-7026
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Provider Business Mailing Address
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Address Line | 624 W SPRINGFIELD ST
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City | AURORA
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State | MO
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Zip | 65605-1850
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Country | US
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Telephone | 417-678-6101
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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 | 2006020322
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License Number State | MO
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