Healthcare Provider Details

I. General information

NPI: 1669308557
Provider Name (Legal Business Name): ELIZABETH NICOLE RAUSCH COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2709
US

IV. Provider business mailing address

1400 S NOVA RD APT 213
DAYTONA BEACH FL
32114-5848
US

V. Phone/Fax

Practice location:
  • Phone: 386-425-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA19949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: