Healthcare Provider Details

I. General information

NPI: 1053745638
Provider Name (Legal Business Name): JEANNE MARIE HOFF COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 BUCKHORN RD
SYKESVILLE MD
21784-9303
US

IV. Provider business mailing address

3934 LONDON BRIDGE RD
SYKESVILLE MD
21784-9515
US

V. Phone/Fax

Practice location:
  • Phone: 410-795-2737
  • Fax:
Mailing address:
  • Phone: 443-789-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA00173
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: