Healthcare Provider Details

I. General information

NPI: 1689276081
Provider Name (Legal Business Name): DEANNA MIXON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6046 BRECKSVILLE RD
INDEPENDENCE OH
44131-1535
US

IV. Provider business mailing address

5163 HOMEWOOD AVE
MAPLE HEIGHTS OH
44137-2201
US

V. Phone/Fax

Practice location:
  • Phone: 919-861-2441
  • Fax:
Mailing address:
  • Phone: 216-632-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number356267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: