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General NPI Number Information
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NPI Number | 1154294742
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Entity Type | Individual
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Provider Name | KETURA ROSALVA COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 301 CAMINO GARDENS BLVD STE 100
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City | BOCA RATON
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State | FL
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Zip | 33432-5823
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Country | US
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Telephone | 561-494-4499
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Fax |
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Provider Business Mailing Address
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Address Line | 4363 SW 10TH PL APT 208
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-8307
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Country | US
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Telephone | 973-640-3219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 20355
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License Number State | FL
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