Healthcare Provider Details

I. General information

NPI: 1710898259
Provider Name (Legal Business Name): JAQUELINE COTA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4114 W NOB HILL BLVD
YAKIMA WA
98908-3900
US

IV. Provider business mailing address

4114 W NOB HILL BLVD
YAKIMA WA
98908-3900
US

V. Phone/Fax

Practice location:
  • Phone: 509-972-4000
  • Fax: 509-972-4001
Mailing address:
  • Phone: 509-972-4000
  • Fax: 509-972-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA70163020
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: