Healthcare Provider Details

I. General information

NPI: 1104339977
Provider Name (Legal Business Name): AIMEE SARDINAS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17670 NW 78TH AVE STE 113
HIALEAH FL
33015-3665
US

IV. Provider business mailing address

11856 SW 98TH TER
MIAMI FL
33186-2766
US

V. Phone/Fax

Practice location:
  • Phone: 305-512-5757
  • Fax: 305-512-5755
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA16110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: