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General NPI Number Information
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NPI Number | 1154981405
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Entity Type | Individual
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Provider Name | JODIE REITZ COTA
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 12105 AMBASSADOR DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-3642
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Country | US
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Telephone | 800-335-1060
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Fax |
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Provider Business Mailing Address
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Address Line | 3625 RIALTO HTS # 3-042
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-8631
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Country | US
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Telephone | 559-978-1508
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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 | 4810
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License Number State | CA
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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 | 0001191
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License Number State | CO
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