Healthcare Provider Details

I. General information

NPI: 1437749215
Provider Name (Legal Business Name): CIERA DY'SHAI COTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 TURKEY LAKE RD
ORLANDO FL
32819-4200
US

IV. Provider business mailing address

131 DWELL DR
KISSIMMEE FL
34747-6467
US

V. Phone/Fax

Practice location:
  • Phone: 321-732-3723
  • Fax:
Mailing address:
  • Phone: 407-486-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number18094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: