Healthcare Provider Details

I. General information

NPI: 1114854502
Provider Name (Legal Business Name): CASSIE JO LEITH COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 PRIVATE DRIVE 6636
PEDRO OH
45659-8651
US

IV. Provider business mailing address

1019 PRIVATE DRIVE 6636
PEDRO OH
45659-8651
US

V. Phone/Fax

Practice location:
  • Phone: 606-585-4518
  • Fax:
Mailing address:
  • Phone: 304-638-3767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number517899
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: