Healthcare Provider Details

I. General information

NPI: 1487301495
Provider Name (Legal Business Name): KHYLA MARILYN FRITZ COTA, BT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 OAK ST # 3
PITTSTON PA
18640-3716
US

IV. Provider business mailing address

12 FAIRVIEW PARK
MOUNTAIN TOP PA
18707-1312
US

V. Phone/Fax

Practice location:
  • Phone: 888-726-4774
  • Fax:
Mailing address:
  • Phone: 570-262-5924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP009993
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: