MEDICARE: MRS. MARISA LEIGH DUIVEN COTA

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	5202004693	MI

General Provider Information

NPI Number	:	1821023128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARISA LEIGH DUIVEN COTA

Provider Business Mailing Address
First Line	:	1979 JANSEN WOODS CT
Second Line	:
City	:	DORR
State	:	MI
Zip	:	49323-9452
Country	:	US
Telephone Number	:	616-970-4306
Fax Number	:

Provider Business Practice Location Address
First Line	:	3491 M40
Second Line	:
City	:	HAMILTON
State	:	MI
Zip	:	49419
Country	:	US
Telephone Number	:	369-751-2150
Fax Number	:	269-751-2140

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/16/2012

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