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General NPI Number Information
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NPI Number | 1104318518
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Entity Type | Individual
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Provider Name | LAUREL GAUDIN COTA
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Gender | Female
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 1333 WELLS ST
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City | NILES
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State | MI
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Zip | 49120-1543
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Country | US
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Telephone | 269-240-7780
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Fax |
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Provider Business Mailing Address
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Address Line | 30 S 4TH ST APT 2
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City | NILES
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State | MI
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Zip | 49120-2743
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Country | US
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Telephone | 269-240-7780
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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 | 32001655A
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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 | 5202007304
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License Number State | MI
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