Healthcare Provider Details

I. General information

NPI: 1639005432
Provider Name (Legal Business Name): ANDI ROSE KILPATRICK COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 SE COVE RD
STUART FL
34997-1602
US

IV. Provider business mailing address

3058 QUINEBAUG RD
FORT MILL SC
29715-1403
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-9440
  • Fax:
Mailing address:
  • Phone: 305-394-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: