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General NPI Number Information
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NPI Number | 1073914354
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Entity Type | Individual
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Provider Name | GRACE SWOOPES COTA
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Gender | Female
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 09/05/2014
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Provider Practice Location Address
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Address Line | 4310 E GRANT RD
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City | TUCSON
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State | AZ
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Zip | 85712-2607
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Country | US
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Telephone | 520-704-6734
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Fax |
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Provider Business Mailing Address
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Address Line | 2414 W RAU RIVER RD
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City | TUCSON
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State | AZ
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Zip | 85705-4934
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Country | US
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Telephone | 520-302-7217
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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 | 5666
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License Number State | AZ
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