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General NPI Number Information
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NPI Number | 1184123564
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Entity Type | Individual
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Provider Name | JENNIFER RENEE MARCIANO COTA
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Gender | Female
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 4560 SE INTERNATIONAL WAY STE 100
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City | MILWAUKIE
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State | OR
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Zip | 97222-4628
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Country | US
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Telephone | 469-863-9551
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Fax |
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Provider Business Mailing Address
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Address Line | 10585 NW SKYLINE BLVD
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City | PORTLAND
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State | OR
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Zip | 97231-2616
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Country | US
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Telephone | 469-863-9551
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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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 | 391370
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License Number State | OR
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