Healthcare Provider Details

I. General information

NPI: 1689836991
Provider Name (Legal Business Name): EDITH TIONKO PLOTNER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 RUSH RIVER DR
SACRAMENTO CA
95831-4602
US

IV. Provider business mailing address

4413 SHENANGO WAY
ELK GROVE CA
95758-4059
US

V. Phone/Fax

Practice location:
  • Phone: 916-428-2213
  • Fax:
Mailing address:
  • Phone: 916-684-8928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: