Healthcare Provider Details

I. General information

NPI: 1114408309
Provider Name (Legal Business Name): VIRNEQUA SYKES COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 OXON HILL RD # 480
OXON HILL MD
20745-1117
US

IV. Provider business mailing address

9300 CORPORATE BLVD APT 1333
ROCKVILLE MD
20850-3794
US

V. Phone/Fax

Practice location:
  • Phone: 301-238-4788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA02533
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: