Healthcare Provider Details

I. General information

NPI: 1730302035
Provider Name (Legal Business Name): REBECCA DIEL BRAKEFIELD COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3177 STERLINGTON RD
MONROE LA
71203-2517
US

IV. Provider business mailing address

12615 LAZY OAKS DR
BASTROP LA
71220-7564
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-1989
  • Fax:
Mailing address:
  • Phone: 318-348-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-Z20465
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: