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General NPI Number Information
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NPI Number | 1063670404
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Entity Type | Individual
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Provider Name | JESSICA S WOODS COTA
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Gender | Female
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Dates
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Enumeration Date | 05/31/2008
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 14154 S DENNY BLVD
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-9431
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Country | US
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Telephone | 623-537-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 11443 N 91ST DR
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City | PEORIA
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State | AZ
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Zip | 85345-5550
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Country | US
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Telephone | 928-910-9394
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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 | 32001614A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 4158
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License Number State | AZ
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