Provider Demographics
NPI:1932370590
Name:TRENTACOSTI, KERRI JO (COTA)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:JO
Last Name:TRENTACOSTI
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 1:5939 BRIGHTON MEADOWS DR
Mailing Address - Street 2:APT. C
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5939 BRIGHTON MEADOWS DR
Practice Address - Street 2:APT. C
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7664
Practice Address - Country:US
Practice Address - Phone:260-750-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3092224Z00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No174400000XOther Service ProvidersSpecialist