Healthcare Provider Details

I. General information

NPI: 1386364958
Provider Name (Legal Business Name): TIFFANY RAE TINO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N DIXIE HWY STE 116
BOCA RATON FL
33432-1807
US

IV. Provider business mailing address

1048 SW 21ST AVE
BOCA RATON FL
33486-8523
US

V. Phone/Fax

Practice location:
  • Phone: 844-397-5011
  • Fax:
Mailing address:
  • Phone: 518-421-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number359826
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: