Healthcare Provider Details

I. General information

NPI: 1043381718
Provider Name (Legal Business Name): JULIE ANN PATTERSON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BIDDLE ST
WYANDOTTE MI
48192-4668
US

IV. Provider business mailing address

28120 GRANDE DR
ROMULUS MI
48174-2979
US

V. Phone/Fax

Practice location:
  • Phone: 734-246-9037
  • Fax:
Mailing address:
  • Phone: 734-775-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number985762
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number5202002704
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: