MEDICARE: MRS. JONI SANTISTEVAN COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	0001674	WA
2	224Z00000X	Occupational Therapy Assistant	OC61487586	WI

General Provider Information

NPI Number	:	1316760382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JONI SANTISTEVAN COTA/L

Provider Business Mailing Address
First Line	:	1605 WOODRIDGE DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3818
Country	:	US
Telephone Number	:	360-443-2399
Fax Number	:	360-443-6121

Provider Business Practice Location Address
First Line	:	1605 WOODRIDGE DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3818
Country	:	US
Telephone Number	:	360-443-2399
Fax Number	:	360-443-6121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2024
Last Update Date	:	12/01/2025

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