Healthcare Provider Details

I. General information

NPI: 1487991311
Provider Name (Legal Business Name): JUDY ANN PETERSEN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 3RD AVE S
SEATTLE WA
98134-1923
US

IV. Provider business mailing address

2445 3RD AVE S
SEATTLE WA
98134-1923
US

V. Phone/Fax

Practice location:
  • Phone: 206-252-0853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOC60309174
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: