Healthcare Provider Details

I. General information

NPI: 1679788756
Provider Name (Legal Business Name): JAMES M EDWARDS COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 CAMPBELL ST
VALPARAISO IN
46385-2363
US

IV. Provider business mailing address

9256 HAYES ST APT 201
MERRILLVILLE IN
46410-6582
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-1023
  • Fax:
Mailing address:
  • Phone: 219-736-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32001284A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: