Healthcare Provider Details

I. General information

NPI: 1184183097
Provider Name (Legal Business Name): KADY PRISCILLA GARCIA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S 10TH ST
HAINES CITY FL
33844-5602
US

IV. Provider business mailing address

306 S 10TH ST STE 340
HAINES CITY FL
33844-5602
US

V. Phone/Fax

Practice location:
  • Phone: 407-913-1010
  • Fax:
Mailing address:
  • Phone: 407-913-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number16919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: