Healthcare Provider Details

I. General information

NPI: 1073833224
Provider Name (Legal Business Name): MAUREEN LEE VASILE OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAUREEN LEE SOPORITO COTA/L

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 3RD ST
KALONA IA
52247-9493
US

IV. Provider business mailing address

2434 RUSHMORE DR
IOWA CITY IA
52246-4138
US

V. Phone/Fax

Practice location:
  • Phone: 319-656-2421
  • Fax:
Mailing address:
  • Phone: 319-333-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number00271
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: