Healthcare Provider Details

I. General information

NPI: 1659262152
Provider Name (Legal Business Name): PAULA MARIE MCVEAGH COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2025
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 KEMPTON ST
SPRING VALLEY CA
91977-5810
US

IV. Provider business mailing address

12741 LAUREL ST UNIT 72
LAKESIDE CA
92040-2137
US

V. Phone/Fax

Practice location:
  • Phone: 619-865-5876
  • Fax:
Mailing address:
  • Phone: 619-865-5876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: