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General NPI Number Information
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NPI Number | 1962878496
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Entity Type | Individual
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Provider Name | IVETTE ESCARCEGA COTA
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Gender | Female
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 3409 NE 62 AVE APT 55
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City | VANCOUVER
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State | WA
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Zip | 98661
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Country | US
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Telephone | 915-207-3924
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Fax |
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Provider Business Mailing Address
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Address Line | 3409 NE 62ND AVE APT 55
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City | VANCOUVER
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State | WA
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Zip | 98661-0207
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Country | US
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Telephone | 915-207-3924
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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 | 311748
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License Number State | OR
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