MEDICARE: HEATHER BONDY 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	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1992440507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER BONDY COTA/L

Provider Business Mailing Address
First Line	:	3536 SANTA CARLOTTA ST
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-1115
Country	:	US
Telephone Number	:	818-433-8057
Fax Number	:

Provider Business Practice Location Address
First Line	:	3536 SANTA CARLOTTA ST
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-1115
Country	:	US
Telephone Number	:	818-433-8057
Fax Number	:

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

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	04/28/2022

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Directions to “ HEATHER BONDY COTA/L” Practice Location

Language	Start Address	Practice Location

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