Healthcare Provider Details

I. General information

NPI: 1356149108
Provider Name (Legal Business Name): EMMA KATE IWANIW COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5042 42ND ST S
ST PETERSBURG FL
33711-4720
US

IV. Provider business mailing address

5042 42ND ST S
ST PETERSBURG FL
33711-4720
US

V. Phone/Fax

Practice location:
  • Phone: 727-871-2784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: