Healthcare Provider Details

I. General information

NPI: 1083646533
Provider Name (Legal Business Name): ADRIENE JANETTE JOHNSTON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 FRONTAGE RD SUITE 2415 SELECT REHAB
NORTHFIELD OH
44067
US

IV. Provider business mailing address

7427 MAYSVILLE RD
FORT WAYNE IN
46815-8022
US

V. Phone/Fax

Practice location:
  • Phone: 877-787-3422
  • Fax:
Mailing address:
  • Phone: 260-445-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32001354A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: