Healthcare Provider Details

I. General information

NPI: 1841034832
Provider Name (Legal Business Name): JASON CLYDE COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 ASSISI HTS
COLORADO SPRINGS CO
80919-3853
US

IV. Provider business mailing address

7550 ASSISI HTS
COLORADO SPRINGS CO
80919-3853
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-1336
  • Fax:
Mailing address:
  • Phone: 931-561-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0001865
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: