Healthcare Provider Details

I. General information

NPI: 1801656533
Provider Name (Legal Business Name): ROSE MARIE SANCHEZ COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 GAZEBO CIR APT 6205
WEST MELBOURNE FL
32904-5239
US

IV. Provider business mailing address

887 GAZEBO CIR APT 6205
WEST MELBOURNE FL
32904-5239
US

V. Phone/Fax

Practice location:
  • Phone: 321-261-7669
  • Fax:
Mailing address:
  • Phone: 321-261-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number19493
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: