Healthcare Provider Details

I. General information

NPI: 1508518762
Provider Name (Legal Business Name): JACI ATKINSON COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 SE 58TH AVE
OCALA FL
34480-5840
US

IV. Provider business mailing address

4616 NW 219TH ST
LAWTEY FL
32058-3530
US

V. Phone/Fax

Practice location:
  • Phone: 352-620-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: