Healthcare Provider Details

I. General information

NPI: 1710215884
Provider Name (Legal Business Name): MONSURAT LAYENI COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SUBURBAN PKWY
HAMPTON VA
23661-2346
US

IV. Provider business mailing address

4 SUBURBAN PKWY
HAMPTON VA
23661-2346
US

V. Phone/Fax

Practice location:
  • Phone: 757-928-0126
  • Fax:
Mailing address:
  • Phone: 757-928-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131000544
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number0131000544
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: