Healthcare Provider Details

I. General information

NPI: 1619848884
Provider Name (Legal Business Name): TAYLOR LEE EAMES COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7776 S POINTE PKWY W STE 250
PHOENIX AZ
85044-5428
US

IV. Provider business mailing address

1849 S POWER RD APT 2364
MESA AZ
85206-4334
US

V. Phone/Fax

Practice location:
  • Phone: 480-518-7073
  • Fax: 480-564-5775
Mailing address:
  • Phone: 616-755-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-050190
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: