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NPI Code Detail

MEDICARE: JADE RHIANNON SANTIAGO COTAL

MEDICARE: JADE RHIANNON SANTIAGO COTAL
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
1224Z00000XOccupational Therapy AssistantL706111MI

General Provider Information

NPI Number : 1588032643
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADE RHIANNON SANTIAGO COTAL
Provider Business Mailing Address
First Line : 537 SUPERIOR BLVD
Second Line :
City : WYANDOTTE
State : MI
Zip : 48192-5030
Country : US
Telephone Number : 734-818-9359
Fax Number :
Provider Business Practice Location Address
First Line : 210 TOWN CENTER DR
Second Line :
City : TROY
State : MI
Zip : 48084-1774
Country : US
Telephone Number : 248-643-8900
Fax Number : 248-740-3505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2015
Last Update Date : 09/07/2015

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