Healthcare Provider Details

I. General information

NPI: 1457271439
Provider Name (Legal Business Name): MARIA MELBO COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 UNIVERSITY DR SE
SAINT CLOUD MN
56304-2023
US

IV. Provider business mailing address

555 VICTORY AVE APT 204
SARTELL MN
56377-4813
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-9120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number202931
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: