Healthcare Provider Details

I. General information

NPI: 1962695742
Provider Name (Legal Business Name): WENDY SUE BEACH COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S PATTERSON AVE
SANTA BARBARA CA
93111-2006
US

IV. Provider business mailing address

16450 LONE PINE RD
COTTONWOOD CA
96022-8531
US

V. Phone/Fax

Practice location:
  • Phone: 805-964-4871
  • Fax:
Mailing address:
  • Phone: 530-646-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: