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General NPI Number Information
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NPI Number | 1063122653
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Entity Type | Individual
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Provider Name | MARVIN LACEY COTA
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Gender | Male
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 10133 SHERRILL BLVD
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City | KNOXVILLE
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State | TN
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Zip | 37932-3347
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Country | US
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Telephone | 929-342-0706
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 KEY ST APT 4L
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City | TOLEDO
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State | OH
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Zip | 43614-4818
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Country | US
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Telephone | 419-917-2322
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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 | 224ZE0001X
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Taxonomy Name | Environmental Modification Occupational Therapy Assistant
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License Number | 0625
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License Number State |
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