Healthcare Provider Details

I. General information

NPI: 1891559084
Provider Name (Legal Business Name): DAYNA MORO COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 W MOHAWK LN
PHOENIX AZ
85027-5946
US

IV. Provider business mailing address

2014 E LIBRA DR
TEMPE AZ
85283-3322
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-3700
  • Fax:
Mailing address:
  • Phone: 408-826-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-050000
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: