Healthcare Provider Details

I. General information

NPI: 1154526580
Provider Name (Legal Business Name): DAWN CHRISITINE HOVER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2007
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 OWENS ST N
STILLWATER MN
55082-4316
US

IV. Provider business mailing address

6336 22ND ST N
OAKDALE MN
55128-4117
US

V. Phone/Fax

Practice location:
  • Phone: 651-275-2624
  • Fax:
Mailing address:
  • Phone: 651-402-7054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number201334
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: