Healthcare Provider Details

I. General information

NPI: 1598976193
Provider Name (Legal Business Name): KATHRYN LEE CARMALT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 LAKE LYNDA DR SUITE 207
ORLANDO FL
32817-8324
US

IV. Provider business mailing address

3505 LAKE LYNDA DR SUITE 207
ORLANDO FL
32817-8324
US

V. Phone/Fax

Practice location:
  • Phone: 877-896-3660
  • Fax:
Mailing address:
  • Phone: 877-896-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA9182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: