Healthcare Provider Details

I. General information

NPI: 1750150561
Provider Name (Legal Business Name): LEANNA KELLI HAMMETT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6635 W HAPPY VALLEY RD STE A104-218
GLENDALE AZ
85310-2609
US

IV. Provider business mailing address

9245 N CENTIPEDE AVE
TUCSON AZ
85742-8331
US

V. Phone/Fax

Practice location:
  • Phone: 623-224-1214
  • Fax:
Mailing address:
  • Phone: 520-784-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-046693
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: