Healthcare Provider Details

I. General information

NPI: 1538008636
Provider Name (Legal Business Name): ASPEN ANGELICA MILLAN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 N TATUM BLVD STE 3031
PHOENIX AZ
85028-1621
US

IV. Provider business mailing address

3142 W MELVIN ST
PHOENIX AZ
85009-4230
US

V. Phone/Fax

Practice location:
  • Phone: 602-708-9412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-050196
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: