Healthcare Provider Details

I. General information

NPI: 1275296527
Provider Name (Legal Business Name): COLIN MCNEELEY COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 7TH ST
WHITEFISH MT
59937-2850
US

IV. Provider business mailing address

1305 7TH ST
WHITEFISH MT
59937-2850
US

V. Phone/Fax

Practice location:
  • Phone: 406-362-3557
  • Fax:
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number9037
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-188666
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: