Healthcare Provider Details

I. General information

NPI: 1013513605
Provider Name (Legal Business Name): JILLIAN BEDNAR COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W HANOVER AVE.
MORRISTOWN NJ
07960-2500
US

IV. Provider business mailing address

540 W HANOVER AVE
MORRISTOWN NJ
07960-2500
US

V. Phone/Fax

Practice location:
  • Phone: 973-600-2127
  • Fax:
Mailing address:
  • Phone: 973-600-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09130400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: