Healthcare Provider Details

I. General information

NPI: 1356097612
Provider Name (Legal Business Name): LISA MARIE GEYER COTA, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6982 PINE FOREST RD
PENSACOLA FL
32526-8909
US

IV. Provider business mailing address

6552 LARK AVE
MILTON FL
32570-3876
US

V. Phone/Fax

Practice location:
  • Phone: 814-591-0586
  • Fax:
Mailing address:
  • Phone: 814-591-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA9992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: