Healthcare Provider Details

I. General information

NPI: 1740938505
Provider Name (Legal Business Name): MIRIAM COCKERHAM COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 ROCK SPRING RD
FOREST HILL MD
21050-2631
US

IV. Provider business mailing address

630 ROBERTS CT
ABERDEEN MD
21001-2308
US

V. Phone/Fax

Practice location:
  • Phone: 443-619-7712
  • Fax:
Mailing address:
  • Phone: 443-966-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberA03046
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA03046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: