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General NPI Number Information
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NPI Number | 1629286661
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Entity Type | Individual
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Provider Name | LISA YATES COTA L
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 301 PERKINS DR STE B
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City | LAS CRUCES
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State | NM
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Zip | 88005-3248
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Country | US
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Telephone | 505-523-7243
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Fax |
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Provider Business Mailing Address
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Address Line | 851 W ASH ST
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City | DEMING
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State | NM
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Zip | 88030-3449
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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 | 2074
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License Number State | NM
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