Healthcare Provider Details

I. General information

NPI: 1548186703
Provider Name (Legal Business Name): NICOLE MARIE HYLAND COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1394 JACKSON ST
SAINT PAUL MN
55117-4629
US

IV. Provider business mailing address

3842 BALLANTRAE RD APT 3
EAGAN MN
55122-1513
US

V. Phone/Fax

Practice location:
  • Phone: 651-603-8774
  • Fax:
Mailing address:
  • Phone: 507-210-6662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number202684
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: