Healthcare Provider Details

I. General information

NPI: 1538411897
Provider Name (Legal Business Name): MICHAEL DAVID PATRICK COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 ROBINSON RD
JACKSON MI
49203-2538
US

IV. Provider business mailing address

13432 CORNELL RD
CONCORD MI
49237-9725
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-5140
  • Fax:
Mailing address:
  • Phone: 989-808-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3081088
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: