Healthcare Provider Details

I. General information

NPI: 1750828786
Provider Name (Legal Business Name): CASSIA MCDOWELL COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2017
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 CHURCH ROCK ST
GALLUP NM
87301-4572
US

IV. Provider business mailing address

4249 SHANNA ST
GRAND ISLAND NE
68803-2903
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-2261
  • Fax:
Mailing address:
  • Phone: 308-850-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number948
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1114
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-2026-0003
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: