Healthcare Provider Details

I. General information

NPI: 1043124522
Provider Name (Legal Business Name): LARISSA ANN MORRISON COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 S ANKENY BLVD
ANKENY IA
50023-3141
US

IV. Provider business mailing address

1338 WALTON DR UNIT 105
AMES IA
50014-5510
US

V. Phone/Fax

Practice location:
  • Phone: 515-261-2402
  • Fax:
Mailing address:
  • Phone: 319-404-9488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number139774
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: