Healthcare Provider Details

I. General information

NPI: 1548006430
Provider Name (Legal Business Name): EMILY ANNE SUNDELL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ANNE SUNDELL COTA

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 45TH AVE N APT 16A
ROBBINSDALE MN
55422-1366
US

IV. Provider business mailing address

4400 45TH AVE N APT 16A
ROBBINSDALE MN
55422-1366
US

V. Phone/Fax

Practice location:
  • Phone: 612-618-0773
  • Fax:
Mailing address:
  • Phone: 612-618-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number202351
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number202351
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: