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General NPI Number Information
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NPI Number | 1164992913
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Entity Type | Individual
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Provider Name | GENITA SEATON COTA
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Gender | Female
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 13820 S 44TH ST APT 1241
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City | PHOENIX
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State | AZ
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Zip | 85044-4864
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Country | US
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Telephone | 312-785-5280
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Fax |
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Provider Business Mailing Address
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Address Line | 14536 S UNION AVE
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City | RIVERDALE
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State | IL
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Zip | 60827-2638
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Country | US
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Telephone | 312-785-5280
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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 | 410055
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License Number State | AZ
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