Healthcare Provider Details

I. General information

NPI: 1083003370
Provider Name (Legal Business Name): LAURA D'ANTONA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 FAIRWAY ST
DICKINSON ND
58601-2639
US

IV. Provider business mailing address

803 8TH AVE NE
MANDAN ND
58554-3442
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-4000
  • Fax:
Mailing address:
  • Phone: 410-937-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2087
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: