Provider Demographics
NPI:1831670892
Name:COOTS, WAYNE (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:COOTS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 WELLS FORK RD
Mailing Address - Street 2:
Mailing Address - City:VIPER
Mailing Address - State:KY
Mailing Address - Zip Code:41774-8993
Mailing Address - Country:US
Mailing Address - Phone:606-216-2901
Mailing Address - Fax:
Practice Address - Street 1:71 PIEDMONT FR.
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858
Practice Address - Country:US
Practice Address - Phone:606-216-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY134121225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist