Provider Demographics
NPI:1386214047
Name:KUDA, AUDRY E (COTA)
Entity Type:Individual
Prefix:MRS
First Name:AUDRY
Middle Name:E
Last Name:KUDA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 HIGHWAY ZZ
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63384-4800
Mailing Address - Country:US
Mailing Address - Phone:573-473-2107
Mailing Address - Fax:
Practice Address - Street 1:328 HIGHWAY ZZ
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63384-4800
Practice Address - Country:US
Practice Address - Phone:573-473-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016012311224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant