Healthcare Provider Details

I. General information

NPI: 1033638416
Provider Name (Legal Business Name): KATHLEEN MICHELE HOADLEY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2017
Last Update Date: 09/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E HURON RIVER DR
YPSILANTI MI
48197-1051
US

IV. Provider business mailing address

1864 COLONIAL VILLAGE WAY APT 3
WATERFORD MI
48328-1954
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-6775
  • Fax:
Mailing address:
  • Phone: 248-882-5877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202008298
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: