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General NPI Number Information
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NPI Number | 1447785076
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Entity Type | Individual
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Provider Name | ALESSANDRO BAUTISTA COTA/L
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Gender | Male
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 2821 S WALDEN ST
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City | SEATTLE
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State | WA
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Zip | 98144-6830
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Country | US
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Telephone | 206-577-6298
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Fax |
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Provider Business Mailing Address
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Address Line | 17806 32ND AVE S APT 16
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City | SEATAC
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State | WA
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Zip | 98188-4226
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Country | US
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Telephone | 248-238-5519
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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 | OC60718963
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License Number State | WA
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