Healthcare Provider Details

I. General information

NPI: 1598036105
Provider Name (Legal Business Name): DORA DIANE MCVAY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2464 BALDWIN RD
FENTON MI
48430-9769
US

IV. Provider business mailing address

2464 BALDWIN RD
FENTON MI
48430-9769
US

V. Phone/Fax

Practice location:
  • Phone: 810-513-4743
  • Fax:
Mailing address:
  • Phone: 810-513-4743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202006804
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: