Most Relevant Information
Provider Data
| NPI Number: | 1003222530 |
| Provider Name: | FANNY BRISTOL COTA |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | 933 |
Most Important Dates
| Enumeration Date: | 07/03/2014 |
| Last Updated: | 07/03/2014 |
Provider Practice Location
1016 E 6TH ST
ALLIANCE
NE
693013600
Practice Location Phone/Fax
| Phone: | 3087629000 |
| Fax: |
Provider Mailing Location
PO BOX 313
ALLIANCE
NE
693010313
Provider Mailing Phone/Fax
| Phone: | 3082587541 |
| Fax: |