Healthcare Provider Details

I. General information

NPI: 1790691616
Provider Name (Legal Business Name): ALEXA VICTORIA PINO COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 ELLENWOOD DR
MIDDLETOWN DE
19709-7867
US

IV. Provider business mailing address

317 ELLENWOOD DR
MIDDLETOWN DE
19709-7867
US

V. Phone/Fax

Practice location:
  • Phone: 302-312-0029
  • Fax: 302-314-0070
Mailing address:
  • Phone: 302-312-0029
  • Fax: 302-314-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberU2-0012345
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: