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General NPI Number Information
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NPI Number | 1831549039
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Entity Type | Individual
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Provider Name | ELANIE MONTANO COTA/L
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Gender | Female
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Dates
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Enumeration Date | 06/17/2016
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Last Update Date | 06/17/2016
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Provider Practice Location Address
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Address Line | 4996 E MEDITERRANEAN DR STE D
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2434
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Country | US
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Telephone | 520-249-7595
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Fax |
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Provider Business Mailing Address
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Address Line | 831 E 7TH ST
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City | DOUGLAS
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State | AZ
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Zip | 85607-2926
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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 | 6544
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License Number State | AZ
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