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General NPI Number Information
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NPI Number | 1285935767
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Entity Type | Individual
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Provider Name | MELISSA CAROL RANDOLPH COTA
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Gender | Female
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 13940 N US HIGHWAY 441
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City | LADY LAKE
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State | FL
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Zip | 32159-8908
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Country | US
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Telephone | 352-750-1095
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Fax | 352-750-1096
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Provider Business Mailing Address
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Address Line | 8835 SE 158TH ST
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City | SUMMERFIELD
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State | FL
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Zip | 34491-9629
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Country | US
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Telephone |
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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 | OTA11420
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License Number State | FL
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