Healthcare Provider Details

I. General information

NPI: 1013486190
Provider Name (Legal Business Name): LYNN MARIE KOBES COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2018
Last Update Date: 11/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 WASHINGTON AVE
HOLLAND MI
49423-5205
US

IV. Provider business mailing address

4057 66TH ST
HOLLAND MI
49423-9744
US

V. Phone/Fax

Practice location:
  • Phone: 616-796-3500
  • Fax:
Mailing address:
  • Phone: 616-335-5980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202007142
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: