Healthcare Provider Details

I. General information

NPI: 1801714845
Provider Name (Legal Business Name): ELLIOTT PHILLIPS COTA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3878 RUFFIN RD
SAN DIEGO CA
92123-1842
US

IV. Provider business mailing address

3904 DAY FLOWER CT
COLUMBIA MO
65203-6108
US

V. Phone/Fax

Practice location:
  • Phone: 619-795-9925
  • Fax:
Mailing address:
  • Phone: 573-514-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number71566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: