Healthcare Provider Details

I. General information

NPI: 1396668109
Provider Name (Legal Business Name): MARIE MAUDELENNE MONDESIR COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16751 NE 9TH AVE APT 411
NORTH MIAMI BEACH FL
33162-2532
US

IV. Provider business mailing address

16751 NE 9TH AVE APT 411
NORTH MIAMI BEACH FL
33162-2532
US

V. Phone/Fax

Practice location:
  • Phone: 954-404-4323
  • Fax:
Mailing address:
  • Phone: 954-404-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18216
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: