Healthcare Provider Details

I. General information

NPI: 1780865261
Provider Name (Legal Business Name): ANNETTE YVONNE LANMAN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNETTE YVONNE DORSEY COTA

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 N 19TH AVE
PHOENIX AZ
85021-7967
US

IV. Provider business mailing address

23819 N 73RD ST
SCOTTSDALE AZ
85255-3499
US

V. Phone/Fax

Practice location:
  • Phone: 602-324-6500
  • Fax: 602-324-6520
Mailing address:
  • Phone: 480-419-6690
  • Fax: 480-659-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1200
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: