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General NPI Number Information
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NPI Number | 1992282966
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Entity Type | Individual
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Provider Name | NIKKI FREDERICK COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 10799 ALLIANCE DR
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City | CAMBY
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State | IN
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Zip | 46113-8909
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Country | US
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Telephone | 812-221-9715
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Fax |
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Provider Business Mailing Address
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Address Line | 897 N SHORE BLVD
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City | FRANKLIN
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State | IN
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Zip | 46131-7791
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Country | US
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Telephone | 812-798-7736
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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 | 32002491A
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License Number State | IN
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