Healthcare Provider Details

I. General information

NPI: 1134867302
Provider Name (Legal Business Name): ANDREA ALYSSA HAHN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 07/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 GOLF COURSE RD SE
RIO RANCHO NM
87124-4971
US

IV. Provider business mailing address

2301 GOLF COURSE RD SE
RIO RANCHO NM
87124-4971
US

V. Phone/Fax

Practice location:
  • Phone: 505-302-2431
  • Fax:
Mailing address:
  • Phone: 505-302-2431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA3810
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: