Healthcare Provider Details

I. General information

NPI: 1720902588
Provider Name (Legal Business Name): LUCINDA C RILEY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 PORTAGE ST
KALAMAZOO MI
49001-6508
US

IV. Provider business mailing address

1315 FRANCIS AVE
MUSKEGON MI
49442-4170
US

V. Phone/Fax

Practice location:
  • Phone: 504-300-4953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202009998
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: