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General NPI Number Information
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NPI Number | 1659181964
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Entity Type | Individual
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Provider Name | HILARY VANDERVELDE COTA
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Gender | Female
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 8626 WICKER AVE STE C
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City | SAINT JOHN
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State | IN
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Zip | 46373-9053
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Country | US
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Telephone | 219-440-7930
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Fax | 219-440-7931
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Provider Business Mailing Address
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Address Line | 540 MEADOW RDG
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City | SCHERERVILLE
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State | IN
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Zip | 46375-2985
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Country | US
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Telephone | 219-629-6947
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Fax | 219-440-7931
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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 | 32003659A
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License Number State | IN
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