Individual
MRS. CONNIE MARIE WORTHCOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
682 W SCHOOL BUS LN, SNOWFLAKE, AZ 85937-5262
(928) 536-4156
(928) 536-4156
Mailing address
112 POWER LANE, TAYLOR, AZ 85939-0000
(928) 536-7526
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2253
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2253
COTA
AZ
Enumeration date
10/25/2006
Last updated
07/08/2007
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