Healthcare Provider Details

I. General information

NPI: 1164336186
Provider Name (Legal Business Name): JESSICA TOLEDO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6396 SW MCVEY AVE
REDMOND OR
97756-9069
US

IV. Provider business mailing address

PO BOX 2057
TERREBONNE OR
97760-2057
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-1848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: