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General NPI Number Information
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NPI Number | 1568238152
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Entity Type | Individual
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Provider Name | BREANNA CAROL STRASESKE COTA
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1445 E INDIAN SCHOOL RD # 277
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City | PHOENIX
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State | AZ
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Zip | 85014-4929
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Country | US
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Telephone | 608-443-6054
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Fax |
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Provider Business Mailing Address
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Address Line | 20245 N 32ND DR APT 277
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City | PHOENIX
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State | AZ
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Zip | 85027-0311
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA-046993
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License Number State | AZ
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