Healthcare Provider Details

I. General information

NPI: 1003225996
Provider Name (Legal Business Name): BETH A HUTCHINSON COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 KIRBY LOOP ROAD
FORT PIERCE FL
34981
US

IV. Provider business mailing address

882 JAMAICA AVE
SEBASTIAN FL
32958-5150
US

V. Phone/Fax

Practice location:
  • Phone: 772-577-6964
  • Fax:
Mailing address:
  • Phone: 772-539-1134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA13808
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: