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General NPI Number Information
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NPI Number | 1104533470
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Entity Type | Individual
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Provider Name | IVANNA BOYKO COTA
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Gender | Female
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 516 176TH ST E
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City | SPANAWAY
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State | WA
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Zip | 98387-8335
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Country | US
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Telephone | 253-800-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 14328 SE 256TH PL
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City | KENT
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State | WA
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Zip | 98042-3622
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Country | US
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Telephone | 253-329-3311
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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 | OC61291172
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License Number State | WA
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