Healthcare Provider Details

I. General information

NPI: 1871183285
Provider Name (Legal Business Name): JENNIFER M MONROE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 POWELL DR
DUNDEE MI
48131-8644
US

IV. Provider business mailing address

403 SOMERSET LN
TEMPERANCE MI
48182-3019
US

V. Phone/Fax

Practice location:
  • Phone: 517-266-1481
  • Fax:
Mailing address:
  • Phone: 419-213-0068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA001628
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202002071
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: