Healthcare Provider Details

I. General information

NPI: 1730235284
Provider Name (Legal Business Name): TINA MARIE VACCA COTA,L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 E INDIAN BEND RD STE 123
SCOTTSDALE AZ
85250-4819
US

IV. Provider business mailing address

2314 E JUANITA AVE
MESA AZ
85204-6953
US

V. Phone/Fax

Practice location:
  • Phone: 480-951-6451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1429
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: