Healthcare Provider Details

I. General information

NPI: 1811805831
Provider Name (Legal Business Name): JENNIFER MARY MEDLEY COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E JEFFREY ST
BALTIMORE MD
21225-2040
US

IV. Provider business mailing address

6802 MCCLEAN BLVD
PARKVILLE MD
21234-7200
US

V. Phone/Fax

Practice location:
  • Phone: 410-514-0181
  • Fax:
Mailing address:
  • Phone: 410-514-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA03246
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: