Healthcare Provider Details

I. General information

NPI: 1184884736
Provider Name (Legal Business Name): JANICE A SCOTT COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 CHERRY DR
REYNOLDSVILLE PA
15851-7376
US

IV. Provider business mailing address

247 CHERRY DR
REYNOLDSVILLE PA
15851-7376
US

V. Phone/Fax

Practice location:
  • Phone: 814-653-2713
  • Fax:
Mailing address:
  • Phone: 814-653-2713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP006256
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: