Healthcare Provider Details

I. General information

NPI: 1114279981
Provider Name (Legal Business Name): DANIELLE E FIFITA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 PENNSYLVANIA ST
CARMEL IN
46032-6601
US

IV. Provider business mailing address

335 W 9TH ST UNIT 702
INDIANAPOLIS IN
46202-3157
US

V. Phone/Fax

Practice location:
  • Phone: 317-669-9486
  • Fax:
Mailing address:
  • Phone: 470-825-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32002112A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: