Healthcare Provider Details

I. General information

NPI: 1003502923
Provider Name (Legal Business Name): REBECCA VALMOND COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N CENTRAL AVE STE 110
KISSIMMEE FL
34741-4439
US

IV. Provider business mailing address

2658 PATRICIAN CIRCLE
KISSIMMEE FL
34746-3292
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-7429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number17212
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number17212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: