Healthcare Provider Details

I. General information

NPI: 1427455658
Provider Name (Legal Business Name): TAYLOR SHOUN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 NEWPORT AVE
CHRISTIANA PA
17509-1305
US

IV. Provider business mailing address

41 NEWPORT AVE
CHRISTIANA PA
17509-1305
US

V. Phone/Fax

Practice location:
  • Phone: 610-593-6901
  • Fax: 610-593-0243
Mailing address:
  • Phone: 610-593-6901
  • Fax: 610-593-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberU2-0001524
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: