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General NPI Number Information
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NPI Number | 1962216101
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Entity Type | Individual
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Provider Name | JARROD EVANS HICKS COTA/L
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Gender | Male
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 24 OLD ETNA RD
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City | LEBANON
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State | NH
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Zip | 03766-1937
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Country | US
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Telephone | 603-448-2234
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Fax |
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Provider Business Mailing Address
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Address Line | 655 S WILLOW ST STE 128
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City | MANCHESTER
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State | NH
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Zip | 03103-5723
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Country | US
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Telephone | 603-893-4515
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Fax | 866-420-1055
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | OTA008403
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 1113
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License Number State | NH
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