Healthcare Provider Details

I. General information

NPI: 1073421558
Provider Name (Legal Business Name): TYLER DEMETRI WALSH-JAMES COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TYLER D JAMES COTA/L

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 ARENA BLVD APT 1313
CLERMONT FL
34714-9043
US

IV. Provider business mailing address

2300 ARENA BLVD APT 1313
CLERMONT FL
34714-9043
US

V. Phone/Fax

Practice location:
  • Phone: 516-513-2672
  • Fax:
Mailing address:
  • Phone: 516-513-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA20147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: