Healthcare Provider Details

I. General information

NPI: 1497411557
Provider Name (Legal Business Name): DENISE HARMON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 S HAM LN
LODI CA
95242-3903
US

IV. Provider business mailing address

14113 SARGENT AVE
GALT CA
95632-8806
US

V. Phone/Fax

Practice location:
  • Phone: 209-334-3825
  • Fax:
Mailing address:
  • Phone: 209-224-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: