Healthcare Provider Details

I. General information

NPI: 1093627861
Provider Name (Legal Business Name): HANNAH MICAELA HAYES COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W COVINA BLVD STE 100
SAN DIMAS CA
91773-3205
US

IV. Provider business mailing address

820 OTHELLO ST
ARCADIA CA
91006-4928
US

V. Phone/Fax

Practice location:
  • Phone: 909-706-0970
  • Fax:
Mailing address:
  • Phone: 626-757-5537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: