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General NPI Number Information
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NPI Number | 1992937205
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Entity Type | Individual
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Provider Name | TAMELA S BROUILLETTE COTA
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Gender | Female
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 2775 E LANSING DR
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City | EAST LANSING
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State | MI
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Zip | 48823-7755
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Country | US
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Telephone | 517-332-1616
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Fax |
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Provider Business Mailing Address
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Address Line | 9587 E VERMONTVILLE HWY
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City | DIMONDALE
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State | MI
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Zip | 48821-8766
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Country | US
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Telephone | 517-582-0948
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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 | 5202000777
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License Number State | MI
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