Healthcare Provider Details

I. General information

NPI: 1477533222
Provider Name (Legal Business Name): DEBORAH E THOMAS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 GROVER ST B-2
LYNDEN WA
98264-1539
US

IV. Provider business mailing address

1610 GROVER ST B-2
LYNDEN WA
98264-1539
US

V. Phone/Fax

Practice location:
  • Phone: 360-354-5245
  • Fax:
Mailing address:
  • Phone: 360-354-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOC60184318
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: