Healthcare Provider Details

I. General information

NPI: 1073743845
Provider Name (Legal Business Name): MARIA E SMUNDIN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 OKEECHOBEE BLVD
WEST PALM BEACH FL
33411-2511
US

IV. Provider business mailing address

15235 MEADOW WOOD DR
WELLINGTON FL
33414-9004
US

V. Phone/Fax

Practice location:
  • Phone: 561-478-3702
  • Fax:
Mailing address:
  • Phone: 561-310-2584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-4610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: