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NPI Code Detail

MEDICARE: MS. SIMONE ELAINE BARDEN COTA/L

MEDICARE: MS. SIMONE ELAINE BARDEN COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant1372ND

General Provider Information

NPI Number : 1922402544
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SIMONE ELAINE BARDEN COTA/L
Provider Business Mailing Address
First Line : 2425 24TH AVE W
Second Line : APT 301
City : WILLISTON
State : ND
Zip : 58801-3206
Country : US
Telephone Number : 910-308-1588
Fax Number :
Provider Business Practice Location Address
First Line : 1515 2ND AVE W
Second Line :
City : WILLISTON
State : ND
Zip : 58801-4108
Country : US
Telephone Number : 701-572-6766
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2014
Last Update Date : 10/09/2014

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