Healthcare Provider Details

I. General information

NPI: 1457475097
Provider Name (Legal Business Name): SCOTT JOSEPH VAJNER COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 CHAPMAN RD E
LUTZ FL
33549-5779
US

IV. Provider business mailing address

6113 MARJO DR
TAMPA FL
33617-1332
US

V. Phone/Fax

Practice location:
  • Phone: 813-948-0612
  • Fax: 813-909-2872
Mailing address:
  • Phone: 813-361-5318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA6840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: