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General NPI Number Information
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NPI Number | 1629715966
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Entity Type | Individual
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Provider Name | SHEILA MARIE PRESTON COTA/L
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Gender | Female
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 3855 SUNSHINE DR
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City | KINGMAN
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State | AZ
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Zip | 86409-3427
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Country | US
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Telephone | 928-716-9330
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Fax | 928-496-2083
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Provider Business Mailing Address
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Address Line | 4563 N SO HI BLVD
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City | GOLDEN VALLEY
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State | AZ
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Zip | 86413-9666
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Country | US
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Telephone | 714-831-7090
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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-047069
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License Number State | AZ
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