Healthcare Provider Details

I. General information

NPI: 1184080913
Provider Name (Legal Business Name): CATHELINE MONESTIME EXUM COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHELINE MONESTIME CRANIAL PROSTHESIS

II. Dates (important events)

Enumeration Date: 01/09/2016
Last Update Date: 08/11/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 HIDDEN COURT RD
HOLLYWOOD FL
33023-7466
US

IV. Provider business mailing address

149 HIDDEN COURT RD
HOLLYWOOD FL
33023-7466
US

V. Phone/Fax

Practice location:
  • Phone: 786-246-5268
  • Fax:
Mailing address:
  • Phone: 786-246-5268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberE2XZZCKQTW
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberE2XZZCKQTW
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number213773
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA14951
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: