Healthcare Provider Details

I. General information

NPI: 1952910804
Provider Name (Legal Business Name): PATRICK JEAN-LOUIS COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MELALEUCA LN
PALM SPRINGS FL
33461-5174
US

IV. Provider business mailing address

13837 SHEFFIELD ST
WELLINGTON FL
33414-7643
US

V. Phone/Fax

Practice location:
  • Phone: 561-357-7200
  • Fax:
Mailing address:
  • Phone: 561-275-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA17808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: