Healthcare Provider Details

I. General information

NPI: 1003680034
Provider Name (Legal Business Name): JASMINE RUBY TOMIC COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 E MCDOWELL RD
SCOTTSDALE AZ
85257-4247
US

IV. Provider business mailing address

4010 HOLIDAY DR
NORTON OH
44203-5075
US

V. Phone/Fax

Practice location:
  • Phone: 425-537-4709
  • Fax:
Mailing address:
  • Phone: 330-812-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA008522
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA008522
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: