Healthcare Provider Details

I. General information

NPI: 1427679273
Provider Name (Legal Business Name): NICOLETTE OYAO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 SURRATTS RD
CLINTON MD
20735-3353
US

IV. Provider business mailing address

7520 SURRATTS RD
CLINTON MD
20735-3353
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-1660
  • Fax:
Mailing address:
  • Phone: 301-856-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA02637
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: