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General NPI Number Information
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NPI Number | 1932598190
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Entity Type | Individual
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Provider Name | STACEY MCCLURE COTA
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Gender | Female
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 2885 HARRIS ST
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City | EUREKA
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State | CA
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Zip | 95503-4808
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Country | US
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Telephone | 707-444-9604
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 SILVERADO AVE
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City | MCKINLEYVILLE
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State | CA
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Zip | 95519-9114
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Country | US
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Telephone | 707-601-1662
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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 | 1643
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License Number State | CA
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