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NPI Code Detail

MEDICARE: EKATERINA KOROTKOVA COTA/L

MEDICARE: EKATERINA KOROTKOVA 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
1224Z00000XOccupational Therapy AssistantOTA16120FL

General Provider Information

NPI Number : 1942827779
Entity Type Code : Individual
Provider Name (Legal Business Name) : EKATERINA KOROTKOVA COTA/L
Provider Business Mailing Address
First Line : 2530 LAKE DEBRA DR APT 104
Second Line :
City : ORLANDO
State : FL
Zip : 32835-8733
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3501 W VINE ST STE 130
Second Line :
City : KISSIMMEE
State : FL
Zip : 34741-4660
Country : US
Telephone Number : 407-536-0485
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2020
Last Update Date : 06/27/2020

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Directions to “ EKATERINA KOROTKOVA COTA/L” Practice Location

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