Healthcare Provider Details

I. General information

NPI: 1700729332
Provider Name (Legal Business Name): DEANNA DAY EDWARDS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17800 US HIGHWAY 18
APPLE VALLEY CA
92307-1221
US

IV. Provider business mailing address

8810 C AVE APT 227
HESPERIA CA
92345-1572
US

V. Phone/Fax

Practice location:
  • Phone: 760-646-8000
  • Fax:
Mailing address:
  • Phone: 217-371-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number6789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: