Healthcare Provider Details

I. General information

NPI: 1548823990
Provider Name (Legal Business Name): TOISALON TERIA BING COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 04/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AVENUE B SE
WINTER HAVEN FL
33880-3037
US

IV. Provider business mailing address

5443 YARBOROUGH LN
LAKELAND FL
33812-4166
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-1429
  • Fax:
Mailing address:
  • Phone: 863-937-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA13632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: