Healthcare Provider Details

I. General information

NPI: 1760741755
Provider Name (Legal Business Name): YVETTE ATEH TEBO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BARKER ST
SILVER SPRING MD
20910-1001
US

IV. Provider business mailing address

3905 BLACKBURN LN APT 44
BURTONSVILLE MD
20866-1247
US

V. Phone/Fax

Practice location:
  • Phone: 301-565-0300
  • Fax:
Mailing address:
  • Phone: 240-605-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA02707
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: