Healthcare Provider Details

I. General information

NPI: 1902343486
Provider Name (Legal Business Name): DEBORAH MITCHELL PARKER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH LYNN MITCHELL

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 SURRATTS RD
CLINTON MD
20735-3353
US

IV. Provider business mailing address

4220 4TH ST NW WASHINGTON
WASHINGTON DC
20011-4844
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-1660
  • Fax:
Mailing address:
  • Phone: 202-487-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA02446
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: