Healthcare Provider Details

I. General information

NPI: 1386556074
Provider Name (Legal Business Name): HUNTER WILLIAM DESCHAMP COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 FAIRWAY ST
DICKINSON ND
58601-2639
US

IV. Provider business mailing address

612 8TH ST SE
DICKINSON ND
58601-6130
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-4387
  • Fax:
Mailing address:
  • Phone: 701-690-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number557757
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: