Healthcare Provider Details

I. General information

NPI: 1356882740
Provider Name (Legal Business Name): JENIFER G TAYLOR COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GARDEN CENTER DR
GREENSBURG PA
15601-1351
US

IV. Provider business mailing address

4422 BURMA RD
MONROEVILLE PA
15146-2802
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-8400
  • Fax:
Mailing address:
  • Phone: 412-736-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP007478
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: