Healthcare Provider Details

I. General information

NPI: 1003949231
Provider Name (Legal Business Name): MICHELLE ANN HARRISON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE ANN GOODMAN COTA

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13511 BISCAYNE DR
GRAND ISLAND FL
32735-8926
US

IV. Provider business mailing address

13511 BISCAYNE DR
GRAND ISLAND FL
32735-8926
US

V. Phone/Fax

Practice location:
  • Phone: 863-248-4155
  • Fax: 863-248-4157
Mailing address:
  • Phone: 863-248-4155
  • Fax: 863-248-4157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA9854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: