Healthcare Provider Details

I. General information

NPI: 1952657314
Provider Name (Legal Business Name): TRUDY ANNA GLOVER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11850 9TH STREET NORTH APT 20208
ST PETERSBURG FL
33716
US

IV. Provider business mailing address

11850 9TH ST N APT 20208
SAINT PETERSBURG FL
33716-1619
US

V. Phone/Fax

Practice location:
  • Phone: 727-345-2775
  • Fax:
Mailing address:
  • Phone: 904-305-1912
  • 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: