Healthcare Provider Details

I. General information

NPI: 1215589304
Provider Name (Legal Business Name): JACLYN K O'NEAL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 WESTMINSTER DR
DOVER DE
19904-8717
US

IV. Provider business mailing address

9162 SHARPTOWN RD
LAUREL DE
19956-4308
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-3600
  • Fax:
Mailing address:
  • Phone: 302-841-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: