Healthcare Provider Details

I. General information

NPI: 1366875684
Provider Name (Legal Business Name): JAIME KUTZURA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2013
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date: 10/22/2013
Reactivation Date: 04/08/2022

III. Provider practice location address

724 DELAWARE AVE
FOUNTAIN HILL PA
18015-1108
US

IV. Provider business mailing address

1678 PLEASANT VIEW RD
BETHLEHEM PA
18015-5833
US

V. Phone/Fax

Practice location:
  • Phone: 610-691-6700
  • Fax:
Mailing address:
  • Phone: 610-838-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP007666
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: