Healthcare Provider Details

I. General information

NPI: 1881423416
Provider Name (Legal Business Name): DAWN GARCIA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W EAU GALLIE BLVD STE A
MELBOURNE FL
32935-3185
US

IV. Provider business mailing address

3225 BURDOCK AVE
WEST MELBOURNE FL
32904-9585
US

V. Phone/Fax

Practice location:
  • Phone: 407-694-3603
  • Fax:
Mailing address:
  • Phone: 321-313-2693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA19610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: