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General NPI Number Information
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NPI Number | 1013125533
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Entity Type | Individual
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Provider Name | IRMA PEREZ COTA
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 802 E. HWY 20
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City | MICHIGAN CITY
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State | IN
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Zip | 46360
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Country | US
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Telephone | 219-229-1202
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Fax |
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Provider Business Mailing Address
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Address Line | 405 E MERCHANT ST
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City | NEW BUFFALO
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State | MI
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Zip | 49117-1174
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Country | US
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Telephone | 219-229-1202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 32001095A
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License Number State | IN
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