Healthcare Provider Details

I. General information

NPI: 1760873061
Provider Name (Legal Business Name): DANIELLE GEVA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5245 N SOCRUM LOOP RD
LAKELAND FL
33809-4253
US

IV. Provider business mailing address

3132 FLORAL WAY E
APOPKA FL
32703-6610
US

V. Phone/Fax

Practice location:
  • Phone: 863-859-1446
  • Fax:
Mailing address:
  • Phone: 407-808-0571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP009285
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 14164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: