Provider Demographics
NPI:1538676820
Name:COTA, MIKAYLA ANNE
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:ANNE
Last Name:COTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 PINEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-4041
Mailing Address - Country:US
Mailing Address - Phone:651-380-6429
Mailing Address - Fax:
Practice Address - Street 1:2346 PINEVIEW CT
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-4041
Practice Address - Country:US
Practice Address - Phone:651-380-6429
Practice Address - Fax:651-380-6429
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist