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General NPI Number Information
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NPI Number | 1306256961
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Entity Type | Individual
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Provider Name | DEBORAH GERISILO COTA/L
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Gender | Female
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 15414 N 7TH ST SUITE 3
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City | PHOENIX
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State | AZ
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Zip | 85022-3519
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Country | US
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Telephone | 602-476-7519
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Fax | 602-445-4971
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Provider Business Mailing Address
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Address Line | 28150 N ALMA SCHOOL PKWY
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City | SCOTTSDALE
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State | AZ
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Zip | 85262-8048
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Country | US
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Telephone | 480-262-0496
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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 | 5557
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License Number State | AZ
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