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General NPI Number Information
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NPI Number | 1295301554
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Entity Type | Individual
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Provider Name | NEEDJE BEVERLY TAMBUNGA COTA
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Gender | Female
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 15101 SHELL POINT BLVD
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City | FORT MYERS
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State | FL
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Zip | 33908-1694
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Country | US
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Telephone | 239-466-1131
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 COMPASS RD
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City | GLENVIEW
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State | IL
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Zip | 60026-8001
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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 | 17105
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License Number State | FL
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