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General NPI Number Information
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NPI Number | 1730513300
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Entity Type | Individual
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Provider Name | NIKETA DHAVAL PATEL COTA
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Gender | Female
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Dates
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Enumeration Date | 08/30/2013
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Last Update Date | 08/30/2013
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Provider Practice Location Address
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Address Line | 34330 VAN BORN RD
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City | WAYNE
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State | MI
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Zip | 48184-2472
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Country | US
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Telephone | 734-721-9108
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Fax |
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Provider Business Mailing Address
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Address Line | 39442 DORCHESTER CIR
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City | CANTON
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State | MI
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Zip | 48188-5000
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Country | US
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Telephone | 734-727-1476
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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 | 5202006033
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License Number State | MI
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