Healthcare Provider Details

I. General information

NPI: 1821244021
Provider Name (Legal Business Name): MICHELE SUSAN ZURISK COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6685 E 117TH AVE
CROWN POINT IN
46307-7808
US

IV. Provider business mailing address

12506 PINTAIL CT
CEDAR LAKE IN
46303-8603
US

V. Phone/Fax

Practice location:
  • Phone: 219-663-6392
  • Fax:
Mailing address:
  • Phone: 219-374-3492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: