Healthcare Provider Details

I. General information

NPI: 1376200485
Provider Name (Legal Business Name): MARIE REBECCA HOFMANN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75100 MEDITERRANEAN
PALM DESERT CA
92211-9069
US

IV. Provider business mailing address

1557 E SAN JACINTO WAY
PALM SPRINGS CA
92262-5807
US

V. Phone/Fax

Practice location:
  • Phone: 857-325-4496
  • Fax:
Mailing address:
  • Phone: 857-325-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: