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General NPI Number Information
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NPI Number | 1992488266
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Entity Type | Individual
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Provider Name | OLIVIA MADDEN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 12523 TAYLORSVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40299-4450
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Country | US
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Telephone | 502-694-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 PENNSYLVANIA AVE
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-2702
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Country | US
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Telephone | 502-994-5424
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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 | 267352
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License Number State | KY
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