Healthcare Provider Details

I. General information

NPI: 1750202172
Provider Name (Legal Business Name): ADDISON PARKER PONTIUS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 W CAMELBACK RD
PHOENIX AZ
85015-3403
US

IV. Provider business mailing address

2121 W BUTLER DR
PHOENIX AZ
85021-4292
US

V. Phone/Fax

Practice location:
  • Phone: 602-601-2401
  • Fax:
Mailing address:
  • Phone: 406-740-1894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: