Healthcare Provider Details

I. General information

NPI: 1962327411
Provider Name (Legal Business Name): AVERY MAZOUR COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 CIMARRON PLZ STE 105
HASTINGS NE
68901-2883
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-2077
  • Fax:
Mailing address:
  • Phone: 308-675-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1180
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: