Healthcare Provider Details

I. General information

NPI: 1124588256
Provider Name (Legal Business Name): BRANDI DANIELS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 03/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16106 3RD ST E
REDINGTON BEACH FL
33708-1610
US

IV. Provider business mailing address

16106 3RD ST E
REDINGTON BEACH FL
33708-1610
US

V. Phone/Fax

Practice location:
  • Phone: 813-315-0492
  • Fax:
Mailing address:
  • Phone: 813-315-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number15252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: