Healthcare Provider Details

I. General information

NPI: 1962170787
Provider Name (Legal Business Name): JOSHUA BENNETT COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2021
Last Update Date: 09/06/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 CORSON AVE S
SEATTLE WA
98108-2605
US

IV. Provider business mailing address

724 N 84TH ST
SEATTLE WA
98103-4328
US

V. Phone/Fax

Practice location:
  • Phone: 206-971-7466
  • Fax:
Mailing address:
  • Phone: 206-496-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: