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General NPI Number Information
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NPI Number | 1083925697
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Entity Type | Individual
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Provider Name | CAROLE ANN CAPUTA COTA
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Gender | Female
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 14301 EWING AVE S
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City | BURNSVILLE
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State | MN
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Zip | 55306-4885
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Country | US
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Telephone | 952-746-5350
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Fax | 952-746-6131
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Provider Business Mailing Address
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Address Line | 3153 OLD HIGHWAY 8 #309A
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City | ST ANTHONY
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State | MN
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Zip | 55418-2583
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Country | US
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Telephone |
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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 | 200764
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License Number State | MN
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