Healthcare Provider Details

I. General information

NPI: 1003744673
Provider Name (Legal Business Name): MASON SAUBERT COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 NORTH ST
WAKEFIELD MI
49968-9452
US

IV. Provider business mailing address

75 MICHIGAN AVE
MONTREAL WI
54550-9728
US

V. Phone/Fax

Practice location:
  • Phone: 906-224-9811
  • Fax:
Mailing address:
  • Phone: 906-285-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7163-27
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202010318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: