Healthcare Provider Details

I. General information

NPI: 1619434925
Provider Name (Legal Business Name): JACQUELINE BELL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7016 CHATUM LIGHT RUN
BRADENTON FL
34212-7007
US

IV. Provider business mailing address

7016 CHATUM LIGHT RUN
BRADENTON FL
34212-7007
US

V. Phone/Fax

Practice location:
  • Phone: 941-527-7299
  • Fax: 855-232-8604
Mailing address:
  • Phone: 941-527-7299
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA16995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: