Healthcare Provider Details

I. General information

NPI: 1598492753
Provider Name (Legal Business Name): JULIE ELLEN LIESER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2022
Last Update Date: 08/06/2022
Certification Date: 08/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 PINELLAS POINT DR S
SAINT PETERSBURG FL
33705-6154
US

IV. Provider business mailing address

1190 26TH AVE N
SAINT PETERSBURG FL
33704-2630
US

V. Phone/Fax

Practice location:
  • Phone: 727-677-5087
  • Fax:
Mailing address:
  • Phone: 727-641-0998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA14160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: