Healthcare Provider Details

I. General information

NPI: 1316101652
Provider Name (Legal Business Name): ANGELA JOHNSON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 LILIENTHAL ST
CINCINNATI OH
45204-1170
US

IV. Provider business mailing address

315 LILIENTHAL ST
CINCINNATI OH
45204-1170
US

V. Phone/Fax

Practice location:
  • Phone: 513-244-1506
  • Fax:
Mailing address:
  • Phone: 513-244-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number03291
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: