Healthcare Provider Details

I. General information

NPI: 1316511421
Provider Name (Legal Business Name): ALLISON SLEISTER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON SLEISTER COTA/L

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 08/22/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 DUNN AVE
DAYTONA BEACH FL
32114-2405
US

IV. Provider business mailing address

1538 FORT SMITH BLVD
DELTONA FL
32725-4948
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-4568
  • Fax:
Mailing address:
  • Phone: 386-561-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA16969
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: