Healthcare Provider Details

I. General information

NPI: 1174783443
Provider Name (Legal Business Name): ASHLEY SUE GUZOWSKI COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 US HIGHWAY 2
CRYSTAL FALLS MI
49920-9633
US

IV. Provider business mailing address

1523 US HIGHWAY 2
CRYSTAL FALLS MI
49920-9633
US

V. Phone/Fax

Practice location:
  • Phone: 906-874-1422
  • Fax: 906-874-1442
Mailing address:
  • Phone: 906-874-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202006899
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: