Healthcare Provider Details

I. General information

NPI: 1558607697
Provider Name (Legal Business Name): JULIE M ELLISON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 WINGFIELD HILLS RD
SPARKS NV
89436-7220
US

IV. Provider business mailing address

2350 WINGFIELD HILLS RD
SPARKS NV
89436-7220
US

V. Phone/Fax

Practice location:
  • Phone: 775-335-8275
  • Fax:
Mailing address:
  • Phone: 775-335-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-2667
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: