Healthcare Provider Details

I. General information

NPI: 1164730545
Provider Name (Legal Business Name): LYNDSEY KATHRYN AVERY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2010
Last Update Date: 09/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

1501 SECRET RAVINE PKWY UNIT 222
ROSEVILLE CA
95661-6001
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7248
  • Fax:
Mailing address:
  • Phone: 916-532-7683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 2018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: