Healthcare Provider Details

I. General information

NPI: 1083986640
Provider Name (Legal Business Name): LESLIE PROFIT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2012
Last Update Date: 01/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 18TH ST NW APT 403
WASHINGTON DC
20009-1743
US

IV. Provider business mailing address

1929 18TH ST NW APT 403
WASHINGTON DC
20009-1743
US

V. Phone/Fax

Practice location:
  • Phone: 202-758-7157
  • Fax:
Mailing address:
  • Phone: 202-758-7157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA01838
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: