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General NPI Number Information
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NPI Number | 1053108266
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Entity Type | Individual
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Provider Name | MARISSA GRAHAM COTA
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Gender | Female
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 13413 NE LEROY HAGEN MEMORIAL DR
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City | VANCOUVER
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State | WA
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Zip | 98684-5967
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Country | US
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Telephone | 360-604-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 FAIRWAY DR
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City | KELSO
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State | WA
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Zip | 98626-7900
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Country | US
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Telephone | 405-403-9166
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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 | OC61663621
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License Number State | WA
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