Healthcare Provider Details

I. General information

NPI: 1588891519
Provider Name (Legal Business Name): CARRIE MOTT GEYER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 EAST LN
MILFORD DE
19963-1029
US

IV. Provider business mailing address

708 EAST LN
MILFORD DE
19963-1029
US

V. Phone/Fax

Practice location:
  • Phone: 302-422-0795
  • Fax:
Mailing address:
  • Phone: 302-422-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberU2-0001069
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: