Healthcare Provider Details

I. General information

NPI: 1518283829
Provider Name (Legal Business Name): CELESTIA YOUNG COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 MAIDEN CHOICE LN
BALTIMORE MD
21228-6138
US

IV. Provider business mailing address

140 SANFORD AVE
BALTIMORE MD
21228-5138
US

V. Phone/Fax

Practice location:
  • Phone: 800-222-9651
  • Fax:
Mailing address:
  • Phone: 410-963-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: