Healthcare Provider Details

I. General information

NPI: 1447969175
Provider Name (Legal Business Name): MARINA GEORGE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 S FRANKLIN ST
DENVER CO
80210-5105
US

IV. Provider business mailing address

22045 HILL GAIL WAY
PARKER CO
80138-8363
US

V. Phone/Fax

Practice location:
  • Phone: 719-213-0603
  • Fax:
Mailing address:
  • Phone: 303-359-0725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.0001465
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: