Healthcare Provider Details

I. General information

NPI: 1073646485
Provider Name (Legal Business Name): MARIE M SMEDILE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 N PARK DR
PENNSAUKEN NJ
08109-4643
US

IV. Provider business mailing address

408 KINGS CROFT
CHERRY HILL NJ
08034-1103
US

V. Phone/Fax

Practice location:
  • Phone: 856-665-9111
  • Fax: 856-317-3430
Mailing address:
  • Phone: 856-414-1584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09032800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: