Healthcare Provider Details

I. General information

NPI: 1356679575
Provider Name (Legal Business Name): MAUREEN A ZAGACKI COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2009
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 OAK LANE AVE
PHILADELPHIA PA
19126-3340
US

IV. Provider business mailing address

3694 STANTON ST
PHILADELPHIA PA
19129-1619
US

V. Phone/Fax

Practice location:
  • Phone: 215-570-3818
  • Fax:
Mailing address:
  • Phone: 215-438-5894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP002665L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: