Healthcare Provider Details

I. General information

NPI: 1841917671
Provider Name (Legal Business Name): ELLA DENES COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 COUNTY ROAD 123
HENAGAR AL
35978-7143
US

IV. Provider business mailing address

2710 COUNTY ROAD 123
HENAGAR AL
35978-7143
US

V. Phone/Fax

Practice location:
  • Phone: 256-605-2581
  • Fax:
Mailing address:
  • Phone: 256-605-2581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5922
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: