Healthcare Provider Details

I. General information

NPI: 1275484131
Provider Name (Legal Business Name): JON CALEB SARLI COTA/L, CDRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4263 MONTGOMERY BLVD NE STE 235
ALBUQUERQUE NM
87109-6734
US

IV. Provider business mailing address

4263 MONTGOMERY BLVD NE STE 235
ALBUQUERQUE NM
87109-6734
US

V. Phone/Fax

Practice location:
  • Phone: 480-449-3331
  • Fax: 855-449-4533
Mailing address:
  • Phone: 480-449-3331
  • Fax: 855-449-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA3125
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: