Healthcare Provider Details

I. General information

NPI: 1841594991
Provider Name (Legal Business Name): TAMBRIA KATHLEEN HOWARD COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CHARLEVOIX DR SE SUITE 200
GRAND RAPIDS MI
49546-7085
US

IV. Provider business mailing address

138 SMITH ST
ELLWOOD CITY PA
16117-6468
US

V. Phone/Fax

Practice location:
  • Phone: 616-975-5092
  • Fax:
Mailing address:
  • Phone: 724-544-9584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP001457L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: