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General NPI Number Information
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NPI Number | 1841083169
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Entity Type | Individual
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Provider Name | MAUREEN ANNE BRUCE COTA/L
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Gender | Female
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 363 S FIELDSTONE BLVD
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City | BLOOMINGTON
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State | IN
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Zip | 47403-9809
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Country | US
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Telephone | 812-825-0551
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Fax |
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Provider Business Mailing Address
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Address Line | 610 W PINE LN
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City | ELLETTSVILLE
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State | IN
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Zip | 47429-1450
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Country | US
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Telephone | 219-779-4836
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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 | 32002456A
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License Number State | IN
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