Healthcare Provider Details

I. General information

NPI: 1033702840
Provider Name (Legal Business Name): ANTOINETTE ROSEMARIE CUOMO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 W SUNSET RD STE 204
LAS VEGAS NV
89148-4903
US

IV. Provider business mailing address

9260 W SUNSET RD STE 204
LAS VEGAS NV
89148-4903
US

V. Phone/Fax

Practice location:
  • Phone: 702-355-9862
  • Fax: 888-316-4826
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-2530
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: