Healthcare Provider Details

I. General information

NPI: 1962878496
Provider Name (Legal Business Name): IVETTE ESCARCEGA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 NE 62 AVE APT 55
VANCOUVER WA
98661
US

IV. Provider business mailing address

3409 NE 62ND AVE APT 55
VANCOUVER WA
98661-0207
US

V. Phone/Fax

Practice location:
  • Phone: 915-207-3924
  • Fax:
Mailing address:
  • Phone: 915-207-3924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number311748
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: