Healthcare Provider Details

I. General information

NPI: 1821023128
Provider Name (Legal Business Name): MARISA LEIGH DUIVEN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 M40
HAMILTON MI
49419
US

IV. Provider business mailing address

1979 JANSEN WOODS CT
DORR MI
49323-9452
US

V. Phone/Fax

Practice location:
  • Phone: 369-751-2150
  • Fax: 269-751-2140
Mailing address:
  • Phone: 616-970-4306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202004693
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: