Healthcare Provider Details

I. General information

NPI: 1912276072
Provider Name (Legal Business Name): SORAH ALON COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 SCOTTS HILL DR
BALTIMORE MD
21208-3525
US

IV. Provider business mailing address

1027 SCOTTS HILL DR
BALTIMORE MD
21208-3525
US

V. Phone/Fax

Practice location:
  • Phone: 410-484-0186
  • Fax:
Mailing address:
  • Phone: 410-602-0598
  • Fax: 866-840-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA01595
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-189682
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: