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General NPI Number Information
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NPI Number | 1982123220
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Entity Type | Individual
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Provider Name | STEPHANIE DANIELLE PRIDE COTA
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Gender | Female
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 09/19/2017
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Provider Practice Location Address
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Address Line | 419 N SEMINARY ST
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City | MADISONVILLE
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State | KY
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Zip | 42431-1515
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Country | US
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Telephone | 270-821-5564
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Fax |
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Provider Business Mailing Address
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Address Line | 762 PLAINVIEW DR
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City | MADISONVILLE
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State | KY
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Zip | 42431-3118
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Country | US
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Telephone | 270-584-5429
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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 | 172404
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License Number State | KY
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