Healthcare Provider Details

I. General information

NPI: 1447472261
Provider Name (Legal Business Name): JENNIFER BOWDEN THORNTON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 COMMERCE WAY
DOVER DE
19904-8210
US

IV. Provider business mailing address

201 QUAIL HOLW
MIDDLETOWN DE
19709-9594
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-1500
  • Fax: 302-672-1714
Mailing address:
  • Phone: 302-607-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA00466
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: