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General NPI Number Information
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NPI Number | 1407507353
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Entity Type | Individual
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Provider Name | ANITA JOY EDWARDS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 1059 WEALTHY ST SE UNIT 301
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-1690
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Country | US
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Telephone | 616-777-7631
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Fax |
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Provider Business Mailing Address
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Address Line | 1059 WEALTHY ST SE UNIT 301
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-1690
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Country | US
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Telephone |
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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 | 224ZE0001X
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Taxonomy Name | Environmental Modification Occupational Therapy Assistant
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 5202003641
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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