Healthcare Provider Details

I. General information

NPI: 1033681085
Provider Name (Legal Business Name): KATHLEEN BUSCHING COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INTERGRACE FAIRHAVEN 7200 THIRD AVE
SYKESVILLE MD
21784
US

IV. Provider business mailing address

INTERGRACE FAIRHAVEN 7200 THIRD AVE
SYKESVILLE MD
21784
US

V. Phone/Fax

Practice location:
  • Phone: 410-795-8800
  • Fax:
Mailing address:
  • Phone: 410-795-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number01393
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: