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General NPI Number Information
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NPI Number | 1164995403
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Entity Type | Individual
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Provider Name | LAURIE ANN SQUIRES COTA
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Gender | Female
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 2394 MIDLAND RD
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City | BAY CITY
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State | MI
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Zip | 48706-9402
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Country | US
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Telephone | 989-671-3502
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Fax | 989-671-3502
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Provider Business Mailing Address
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Address Line | 1868 S VILLA CT
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City | ESSEXVILLE
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State | MI
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Zip | 48732-1835
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Country | US
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Telephone | 616-550-9704
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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 | 2701129799
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License Number State | MI
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