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General NPI Number Information
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NPI Number | 1346017266
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Entity Type | Individual
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Provider Name | KELLEY-BETH TRACY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 3310 W COMMERCE RD
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City | MILFORD
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State | MI
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Zip | 48380-3100
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Country | US
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Telephone | 248-685-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 216 HARRISON ST APT 103
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City | CHELSEA
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State | MI
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Zip | 48118-1068
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Country | US
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Telephone | 734-395-2969
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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 | 5202008394
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License Number State | MI
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