Healthcare Provider Details

I. General information

NPI: 1457267932
Provider Name (Legal Business Name): HEIDY VARGAS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 3RD AVE
KINGSTON PA
18704-5845
US

IV. Provider business mailing address

115 EL DR
TAYLOR PA
18517-1003
US

V. Phone/Fax

Practice location:
  • Phone: 570-283-5848
  • Fax:
Mailing address:
  • Phone: 845-893-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP010747
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: