Provider Demographics
NPI:1639870835
Name:KOTOWSKI, KYLE LYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:LYNN
Last Name:KOTOWSKI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 E 7TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2462
Mailing Address - Country:US
Mailing Address - Phone:704-928-6670
Mailing Address - Fax:
Practice Address - Street 1:13825 HUNTON LN # 6190
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6190
Practice Address - Country:US
Practice Address - Phone:704-897-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13432224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant