Healthcare Provider Details

I. General information

NPI: 1548091069
Provider Name (Legal Business Name): RACHEL KESSINGER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2667 ENTERPRISE RD
ORANGE CITY FL
32763-8217
US

IV. Provider business mailing address

2972 JAY CT
DELTONA FL
32738-1055
US

V. Phone/Fax

Practice location:
  • Phone: 321-233-3534
  • Fax:
Mailing address:
  • Phone: 407-227-3920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number19975
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: