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General NPI Number Information
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NPI Number | 1407416381
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Entity Type | Individual
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Provider Name | MARY FRANCES LAQUATRA COTA/L
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Gender | Female
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 8461 LAKE WORTH RD STE 115
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City | LAKE WORTH
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State | FL
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Zip | 33467-2474
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Country | US
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Telephone | 561-345-1064
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Fax |
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Provider Business Mailing Address
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Address Line | 10921 SW DUNHILL CT
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-2403
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Country | US
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Telephone | 561-345-1064
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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 | OTA11752
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License Number State | FL
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